Causes of choking

The causes of suffocation can be grouped as follows.

1. Narrowing or closure of the airway.

• Causes of suffocation that act within the respiratory tract or are associated with respiratory tract pathology.
  • Ingestion of foreign bodies, vomit, water.
  • Blockage with mucus, fibrinous (in diphtheria) plaque, retraction of the tongue.
  • Laryngeal stenosis during influenza and acute respiratory viral infections (“false croup”), as well as against the background of bacterial infections (tonsillitis).
  • Vocal cord dysfunction syndrome.
  • Spasm of the respiratory muscles, severe swelling of the airways.
  • The cause of suffocation may be bronchial asthma, bronchiolitis, carcinoid syndrome, systemic mastocytosis, systemic connective tissue diseases, severe chronic obstructive bronchitis, pulmonary asthma, anaphylaxis, and beta-blocker administration. Suffocation may also occur as a result of an acute inflammatory process in the lungs (pneumonia). Asthma-like conditions are also distinguished in athletes (hyperactivity of the respiratory tract without the development of bronchial asthma), mainly in skiers due to inhalation of cold air, less often in track and field athletes.
  • Localized edema of the respiratory tract (AO, hereditary AO).
  • Tumors of the larynx, trachea, bronchi.
  • Paralysis of the respiratory muscles (polio, myasthenia).
  • Anomalies in the development of the trachea and bronchi.
• Causes of suffocation that have external influences:
  • compression of the neck and chest organs during accidents, suffocation and similar situations;
  • damage to the lymphatic system and subcutaneous tissue of the neck, retropharyngeal and peritonsillar abscess, infectious mononucleosis, Ludwig's angina;
  • tumor diseases of other organs (tumors of the mediastinum, metastases to the lymph nodes of the mediastinum, lymphosarcoma, lymphogranulomatosis), aortic aneurysm; pneumothorax.

2. Cardiovascular causes of suffocation: thromboembolism of the pulmonary artery branches, mural thrombosis of the pulmonary artery, myocardial infarction, heart defects, pericarditis, periarteritis nodosa, acute cardiac tachyarrhythmia, pulmonary edema as a consequence of heart failure.
3. Paralysis of the respiratory center; poisoning with toxins that cause paralysis or spasm of the respiratory muscles or that impair the ability of the blood to transport oxygen.
4. Sleep apnea is a nocturnal suffocation that is not a manifestation of a specific cardiovascular or respiratory disease. It most often occurs in people who are overweight (hypersthenics), especially those with abdominal obesity, but can also occur in normosthenics.
5. Psychogenic suffocation.

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Why does suffocation develop?

The mechanism of development of suffocation is determined by etiological factors. This may be an obstruction of air passage in the respiratory tract (mechanical, stenosis of the upper respiratory tract, bronchial obstruction, etc.), pulmonary edema, damage to the respiratory center or respiratory muscles.

Asthma in bronchial asthma develops due to spasm of the smooth muscles of the respiratory tract, swelling of the mucous membrane, and secretion of thick and viscous mucus. In severe cases, significant areas of the bronchopulmonary system are excluded from gas exchange ("silent lung" during auscultation). In combination with the ineffectiveness of standard bronchodilator therapy, this leads to the development of asthmatic status (status asthmaticus). In this case, severe respiratory failure develops with disturbances in the gas composition of the blood and the drainage function of the bronchi.

Asphyxiation can develop in diseases accompanied by the production of biogenic amines:

Carcinoid is a tumor consisting of APUD system cells producing serotonin, bradykinin, and prostaglandins. Bronchospasm occurs when the tumor is localized in the bronchus (although such localization occurs in only 7% of cases; more often the tumor is localized in the digestive organs).

Systemic mastocytosis (mast cell reticulosis) – suffocation resembles the symptoms of bronchial asthma. Bronchospasm is associated with the release of large amounts of histamine by mast cells.

Edema of the larynx - suffocation is associated with the localization of edema in the upper respiratory tract, in the neck and pharynx area.

And also for the following pathologies:

Pulmonary embolism – the source of emboli in most cases is phlebothrombosis of the pelvic organs and lower extremities

Obstruction of the upper respiratory tract often occurs in children. Its genesis is based on the anatomical and physiological characteristics of the child:

• Narrow airways;
• Loose subglottic space of the larynx;
• Relative weakness of the respiratory muscles.

Viral infections and allergic reactions in such conditions quickly lead to swelling, mucus secretion and the development of stenosis. True croup in diphtheria is associated with the formation of fibrinous films on the vocal cords.

A decrease in the functional activity of the left ventricle (for example, after a myocardial infarction) leads to blood stagnation in the pulmonary circulation, impaired gas exchange and the development of suffocation, called "cardiac asthma". With a sharp weakening of the contractility of the myocardium of the left ventricle, the right ventricle continues to work hard, pumping blood from the systemic and pulmonary circulations. The extreme manifestation of this process is pulmonary edema. Ease of breathing in a sitting position is due to a decrease in the inflow of venous blood to the heart, a decrease in the hydrostatic pressure of the blood in the upper parts of the lungs and an increase in VC. Frequent occurrence of attacks at night is explained by the increased activity of the vagus nerve at this time, which leads to a narrowing of the coronary arteries, deterioration in myocardial nutrition, and an increase in bronchial tone. In addition, during sleep, the blood supply to the respiratory center decreases and its excitability decreases.

Endobronchial tumor growth (e.g., adenoma) leads to the bronchial lumen gradually decreasing and at a certain stage, valve stenosis develops: the bronchial lumen becomes passable during inhalation and completely closes during exhalation, causing an attack of expiratory dyspnea or suffocation. Such a valve mechanism is constantly present in a congenital anomaly - tracheobronchomegaly, when the excessively developed membranous part of the trachea briefly blocks the lumen, which is manifested by a feeling of suffocation, in connection with which one can erroneously assume the presence of bronchial asthma.

Valvular pneumothorax is a valve mechanism of air accumulation in the pleural cavity with the gradual development of severe suffocation - it develops with lung trauma, bronchial cancer, pneumonia.

The type of stridor also depends on the nature of the pathological process.

• Inspiratory stridor indicates a lesion in the glottis or above it.
• Mixed stridor is typical for diseases of the vocal apparatus and trachea.
• Expiratory stridor is observed in cases of bronchial obstruction, aspiration of a foreign body, compression of the bronchi by enlarged lymph nodes, and malignant lymphoma in the area of the roots of the lungs.