Symptoms
Symptoms vary depending on the severity and location of the obstruction, as well as the age of the individual. Common symptoms include:
Noisy breathing: Stridor (a high-pitched whistling sound), wheezing, snoring.
Difficulty breathing: Increased effort to breathe, rapid breathing (tachypnea), shallow breathing.
Retractions: Sucking in of the skin between the ribs, above the sternum (breastbone), or below the ribs during inhalation.
Cough: Barking cough (croup), persistent cough.
Hoarseness or change in voice.
Difficulty swallowing (dysphagia).
Drooling.
Cyanosis: Bluish discoloration of the skin, lips, or nail beds (late sign indicating severe oxygen deprivation).
Anxiety or agitation.
Loss of consciousness (in severe cases).
Causes
Upper airway obstruction can be caused by a variety of factors, including:
Foreign body aspiration: Inhaling objects such as food, toys, or small items, most common in children.
Infections: Croup (laryngotracheobronchitis), epiglottitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess.
Allergic reactions (anaphylaxis): Swelling of the throat and tongue in response to allergens like food, insect stings, or medications.
Trauma: Injury to the face, neck, or airway.
Tumors or growths: Benign or malignant tumors in the airway.
Vocal cord paralysis or dysfunction.
Subglottic stenosis: Narrowing of the airway below the vocal cords (more common in infants and children).
Laryngomalacia or tracheomalacia: Softness or weakness of the cartilage in the larynx or trachea, leading to collapse during breathing (more common in infants).
Angioedema: Swelling of the tissues beneath the skin or mucous membranes, often caused by medications or allergic reactions.
Obstructive Sleep Apnea (OSA): Repetitive episodes of upper airway obstruction during sleep.
Medicine Used
Medications used to treat upper airway obstruction depend on the underlying cause and severity of the obstruction. Common medications include:
Epinephrine: Used in cases of anaphylaxis to reduce swelling and open the airways.
Corticosteroids: Reduce inflammation in the airway, commonly used for croup and other inflammatory conditions. (e.g., Dexamethasone, Prednisolone)
Racemic Epinephrine (inhaled): Used in croup to reduce swelling.
Antibiotics: Used to treat bacterial infections such as epiglottitis, tonsillitis, or abscesses.
Antihistamines: Used to reduce swelling and inflammation due to allergic reactions.
Oxygen: Supplemental oxygen is often administered to improve oxygen saturation.
Bronchodilators: Used if there is an element of bronchospasm contributing to the obstruction (e.g., Albuterol). Note: Medications should only be administered under the guidance of a healthcare professional.
Is Communicable
Whether upper airway obstruction is communicable depends on the underlying cause.
Infectious causes (e.g., croup, tonsillitis): These can be communicable, as the viruses or bacteria causing the infection can spread through respiratory droplets.
Non-infectious causes (e.g., foreign body aspiration, trauma, tumors, allergies): These are not communicable.
Precautions
Precautions depend on the cause of the UAO. General precautions include:
For infectious causes:
Frequent handwashing.
Covering coughs and sneezes.
Avoiding close contact with infected individuals.
Vaccination against relevant respiratory viruses (e.g., influenza, RSV).
For foreign body aspiration:
Supervising young children while they are eating and playing with small objects.
Keeping small objects out of reach of young children.
Cutting food into small pieces for young children.
For allergies:
Avoiding known allergens.
Carrying an epinephrine auto-injector (EpiPen) if prescribed.
For those at risk of anaphylaxis:
Educate individuals at risk and their families on the signs and symptoms of anaphylaxis and how to use an epinephrine auto-injector.
General precautions:
Be aware of the signs and symptoms of UAO.
Seek medical attention immediately if UAO is suspected.
How long does an outbreak last?
The duration of an outbreak depends on the underlying cause of the upper airway obstruction.
Infections: Viral infections like croup typically last for 3-7 days, with symptoms usually peaking around day 3. Bacterial infections can last longer if not treated promptly with antibiotics.
Allergic Reactions: An allergic reaction with UAO can last minutes to hours if untreated, and may resolve quicker with epinephrine and/or other treatments. Repeated exposure to the allergen can cause prolonged symptoms.
Chronic Conditions: Conditions like tumors or vocal cord paralysis cause prolonged obstruction until definitive treatment.
Foreign Body Aspiration: If the airway obstruction is due to foreign body aspiration, after extraction and treatment, the duration will be brief.
How is it diagnosed?
Diagnosis of upper airway obstruction involves a combination of:
Medical History and Physical Examination: Gathering information about the patient's symptoms, medical history, and performing a physical examination to assess breathing sounds, respiratory effort, and other signs of obstruction.
Pulse Oximetry: Measures the oxygen saturation in the blood.
Arterial Blood Gas (ABG): Measures the levels of oxygen and carbon dioxide in the blood.
Imaging Studies:
X-ray: Can help identify foreign bodies, swelling, or other abnormalities in the airway.
CT scan: Provides more detailed images of the airway and surrounding structures.
Laryngoscopy/Bronchoscopy: Direct visualization of the larynx and trachea using a flexible or rigid scope. This can help identify the cause and location of the obstruction.
Allergy Testing: If allergies are suspected.
Blood tests: to rule out infection and to assess inflammation.
Timeline of Symptoms
The timeline of symptoms varies greatly depending on the cause:
Foreign body aspiration: Symptoms occur suddenly and acutely.
Croup: Symptoms typically begin with mild cold-like symptoms, followed by a barking cough, stridor, and difficulty breathing over 12-48 hours.
Epiglottitis: Symptoms develop rapidly over a few hours, including sore throat, difficulty swallowing, drooling, and high fever.
Anaphylaxis: Symptoms develop rapidly within minutes of exposure to the allergen, including hives, itching, swelling, difficulty breathing, and wheezing.
Tumors: Symptoms may develop gradually over weeks or months, including hoarseness, difficulty swallowing, and shortness of breath.
Important Considerations
Severity: Upper airway obstruction can range from mild to life-threatening. Prompt recognition and intervention are critical.
Age: Infants and children are at higher risk due to their smaller airways.
Underlying Conditions: Individuals with pre-existing respiratory conditions may be more vulnerable to the effects of UAO.
Emergency Management: Severe UAO requires immediate medical attention, including potential intubation or tracheostomy to secure the airway.
Prevention: Taking preventive measures, such as avoiding allergens, supervising children around small objects, and seeking prompt treatment for infections, can help reduce the risk of UAO.
Psychological Impact: UAO and related procedures can be frightening. Consider psychological support.
Accurate Documentation: Thorough documentation is crucial for guiding treatment decisions and tracking progress.