Foreign body aspiration into the lower airway in Chinese adults

Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults.

We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center.

The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases).

The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.