Reducing Your Risk of Airway Aspiration from Dysphagia

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Airway aspiration usually occurs when you swallow food or liquid and it "goes down the wrong pipe" into your airway (trachea). 

It can also occur when you are lying down, usually in a flat position, and the content of your stomach refluxes back into your throat where it can be drawn into your airway instead of back down your esophagus and into the stomach again. It doesn't take a lot. We often talk in terms of "particles." This doesn't mean what you might think of as a 'swallow' of food. Think smaller. 

Aspiration is not restricted to food or liquids, but can include "materials" which refers to pretty much anything that can be inhaled into your airway that shouldn't be there. 

Dysphagia is difficulty swallowing that is happening on a regular basis. It can happen because of structural differences, muscular dysfunction, nerve dysfunction, and irritation to the tissue lining the throat and/or esophagus (the food pipe).

Two reasons: risk of pneumonia and risk of malnourishment.

Airway aspiration for any reason can lead to pneumonia. Pneumonia can be draining to say the least. At worst, it can lead to hospitalization and death. See the RSV & Pneumonia discussion towards the bottom half of this page to learn more.

By itself, dysphagia can have a negative impact on your ability to eat and keep yourself appropriately nourished. If a person is choking, coughing, or feeling like something is often stuck in their throat, they may feel less inclined to eat. 

Consider the following options: 

• Exercises to improve your swallowing (some are listed in the next drop-down).
• Taking smaller bites of food and chewing well.
• If liquids are a problem, you may be advised to thicken your drinks with a thickening agent for swallowing concerns.
• If foods are the problem, adding liquid to your mouth when chewing can make tougher foods easier to swallow.
• The position of your head and neck may be a factor when swallowing. A change in position can help. It can be supported by modified cups and straws to make swallowing easier without tipping your head. You can see examples in the Tools & Tips document. 
• Reviewing your dietary patterns with a dietitian to help improve how well you digest food (clear your stomach) and make nutritive changes as needed. And, to consider the best time to eat and to stop eating so that you are less likely to reflux during the night.
• Positioning your head, neck and torso into an elevated position when lying down can help reduce reflux. Some people do this by placing blocks under the legs at the head of your bed to raise it 4" however people then tend to slide towards the foot end of the bed. Others place a wedge cushion on top of their mattress which does pretty well. See below for a tip.
• Medicine can help control gastroesophageal reflux disease (GERD) which can reduce irritation of the lining of the esophagus and reduce the likelihood that you will aspirate on something that has refluxed into your throat.
• There are other options that are more invasive and usually only applied in severe cases that cannot be managed through the methods described above. Your doctor or nurse practitioner can tell you more if these are appropriate.

The wedge tip for elevating your head in bed:

The wedge is like a triangle in shape. It is best to place the wedge so the thin edge of the triangle is at your hips and the thick edge of the triangle is under your head. 

If you place the thin edge under the middle of your back instead of your hips, you can create a kink at the bottom of you esophagus that can end up keeping the valve between your esophagus and your stomach open allowing stomach content to leak upwards. 

You can help keep yourself in the correct position by placing a pillow or other cushion under your knees. This can reduce the likelihood that you will slide down while sleeping. Commercial wedges for under the knees tend to have more grip on their bottoms and do not move as easily as pillows.  

Fair warning: It does take some getting used to.

A handout from HealthlinkBC is located below discussing Dysphagia as is some nice information on aspiration from dysphagia from Cedars-Sinai.

All of these exercises come from Johns Hopkins Medicine and can be found via links at the bottom of this webpage. They help to close your larynx and may improve your swallowing.

Larynx Closure Exercises

• Take a deep breath and hold it. Keep holding your breath while you swallow. Immediately after swallowing, cough. (This is called the supraglottic swallow.) Repeat a few times.
• Inhale and hold your breath very tightly. Bear down (like you are having a bowel movement). Keep holding your breath and bearing down as you swallow. (This is called a super-supraglottic swallow.) Repeat a few times. There is no need to use food or liquid with either of these exercises. This exercise should be done with caution and patients with uncontrolled blood pressure should not do this exercise as bearing down can increase blood pressure.
• Take a breath. Keep holding your breath as you bear down. Hold for a few seconds and then relax. Repeat a few times.
• Hold your breath tightly. Place both hands under your chair. Pull as if you are trying to lift up your chair with you in it. Let go of your breath and say “ahh” while you continue to pull. Relax. Repeat a few times.
• Hold your breath tightly. Turn your head to the left or to the right. Let go of your breath and say “ahh” while your head is still turned. Relax. Repeat a few times.

Tongue Strengthening Exercises

• Stick out your tongue as far as you can. Put something flat like a spoon or tongue depressor on your tongue. Push against your tongue with the flat object, and push your tongue against the object. Hold for a couple of seconds. Repeat 5 times.
• Repeat the exercise above 5 times. This time, put the spoon or depressor below your tongue instead.
• Extend your tongue as far as possible to the corner of your mouth while pushing against a depressor. Hold for a couple of seconds. Relax. Repeat on the other side of your mouth. Repeat the whole process 5 times.
• Extend your tongue to the bumpy part on the top of your mouth right behind your teeth. Then curl your tongue back toward the back of your mouth as far as possible. Hold for a few seconds. Repeat 5 times.
• Inhale and hold your breath very tightly. Bear down like you are having a bowel movement. Keep holding your breath and bearing down as you swallow. This is called a super-supraglottic swallow. Repeat a few times.
• Pretend to gargle while holding your tongue back as far as possible. Repeat.
• Pretend to yawn while holding your tongue back as far as possible. Repeat.
• Do a dry swallow, squeezing all of your swallowing muscles as tightly as you can. Imagine swallowing a vitamin whole, without water. Repeat a few times.

Lip Closure Exercises

• Press your lips tightly together for 5 seconds. Relax and then repeat 5 times.
• Tightly press your lips around a tongue depressor while someone tries to remove it, for 5 seconds. Relax and then repeat 5 times.
• Fill your cheeks with air and move the air from one cheek to the other 5 times, with no air escaping from the lips or nose. Relax and then repeat 5 times.