Foreign Objects in the Airways
Foreign bodies in the airways (foreign body aspiration) refers to the entry of foreign objects into an animal’s airways. In dogs and cats, these foreign bodies can be located in various areas of the respiratory tract – from the nasal passages through the larynx (voice box) and trachea (windpipe) to the bronchi and, in rarer cases, even into the small bronchioles. The anatomy of the airways in dogs and cats differs in some aspects, resulting in different risk profiles for foreign body aspirations.
Dogs are particularly at risk due to their often exploratory behavior, examining objects with their mouths. Cats, on the other hand, are at increased risk of aspirating hair or plant parts due to their grooming habits. Brachycephalic (short-headed) breeds such as Pugs, French Bulldogs, or Persian cats have an increased risk of airway problems, including foreign body aspiration, due to their anatomical peculiarities.
Foreign body aspiration always represents a potential emergency, as it can lead to partial or complete obstruction of the airways depending on the size and position of the foreign body. In the worst case, a life-threatening choking fit can occur if the airflow is completely blocked.
Causes
Foreign objects that partially or completely block the airways —> Choking fit.
Smaller foreign objects lead to severe coughing and can usually be removed by your pet itself.
However, sometimes small bone fragments or grass seeds are inhaled. Such foreign objects can only be removed from the trachea or large bronchi under a short anesthesia using an endoscope.
If you have seen the moment when a foreign object was inhaled, take your pet to a veterinarian immediately.
If your pet appears healthy, has an appetite, but keeps coughing, a foreign object in the lung could also be the reason.
Supplements
The causes of foreign objects in the airways are diverse and often depend on the animal’s behavior and environment. The most common aspirated foreign objects include:
In dogs, toy parts, small balls, bone splinters, and food particles are particularly often inhaled into the airways. This often happens during play when the dog is excited and breathing quickly, or during eating. Blades of grass and plant parts, especially awns (parts of grass ears), pose a particular problem as their barbs can migrate deep into the airways.
In cats, blades of grass, plant parts, and hairballs are common causes of foreign body aspirations. During intensive grooming, cats can accidentally inhale hairs that form into hairballs. Small toy parts or threads can also be aspirated by cats.
Seasonal factors also play a role: In summer, the risk increases due to awns and other plant parts, while during the Christmas season, pine needles or small decorative items can cause more problems.
Certain risk factors increase the likelihood of foreign body aspiration. These include:
- Young, playful animals with exploratory behavior
- Brachycephalic breeds with anatomical peculiarities of the airways
- Animals with neurological disorders or swallowing difficulties
- Situations with increased excitement or stress that lead to rapid, uncoordinated breathing
Symptoms
- Sudden, severe coughing, although no infection is present
- Sudden unusual breathing sounds
- Difficulty breathing
- Gagging
- Bluish discoloration of the mucous membranes
The symptoms of foreign objects in the airways vary greatly depending on the size, position, and duration of the foreign object. Complete obstruction of the upper airways leads to acute, life-threatening respiratory distress, while smaller foreign objects in the lower airways can cause chronic symptoms.
In acute foreign body aspiration, animals typically show:
- Sudden onset of severe coughing or gagging
- Respiratory distress with open mouth and labored breathing
- Restlessness and panic
- Cyanosis (bluish discoloration) of the mucous membranes due to lack of oxygen
- Collapse or unconsciousness in case of complete airway obstruction
In case of partial obstruction or foreign objects in the lower airways, the following symptoms may occur:
- Persistent or recurrent cough that may worsen with activity
- Abnormal breathing sounds such as wheezing, whistling, or rattling
- Increased respiratory rate or effort
- Nasal discharge, sometimes with blood
- Loss of appetite and decreased performance
- Fever in case of secondary infections
The symptoms differ depending on the location of the foreign object:
- Nasal cavity: Sneezing, unilateral nasal discharge, rubbing the nose
- Larynx/pharynx: Gagging, difficulty swallowing, voice changes
- Trachea: Characteristic “tracheal cough reflex”, wheezing sounds
- Bronchi: Localized breathing sounds, chronic cough, possibly fever
In cats, the symptoms may be more subtle than in dogs. They often show less obvious coughing, but more gagging, loss of appetite, and withdrawn behavior.
First Aid
Removing a foreign object is always necessary.
- Open the mouth cavity and check if you can see, grasp, and remove a foreign object
- Do not use any instruments
- Apply the Heimlich maneuver —> Heimlich maneuver (Part 1)
- The animal’s body is grasped from behind/above immediately below the ribs. The hands are closed just behind the animal’s breastbone, and a sudden pressure towards the lungs supports or creates an exhalation thrust, allowing the foreign object to be coughed out.
- Small dogs or cats can be placed over one arm and, if necessary, secured with your own body so that the animal’s back faces the body of the person treating it. The animal’s head should be the lowest point of the animal. Gentle tapping can be used to try to loosen the foreign object and move it outwards.
- Repeat this maneuver several times,
- Even if your pet coughs up individual food particles, take your pet to a veterinarian.
Diagnosis
The diagnosis of foreign bodies in the airways is based on a combination of medical history, clinical examination, and imaging procedures. The pet owner’s observation plays a crucial role in the suspected diagnosis, especially if the moment of aspiration was witnessed.
The clinical examination includes assessment of the airways, auscultation of the lungs, and monitoring of vital parameters. During auscultation, localized breathing sounds or asymmetric lung ventilation may indicate a foreign body. Examination of the oral cavity and pharynx can be helpful for foreign bodies in the upper respiratory tract, however, many foreign bodies are not visible from the outside.
Imaging procedures are usually essential for a definitive diagnosis:
- X-rays of the thorax in two planes can directly show radiopaque foreign bodies or indirect signs such as air pockets, atelectasis (collapsed lung areas), or emphysema
- Computed tomography (CT) provides a more detailed image and can also make non-radiopaque foreign bodies visible
- Ultrasound examinations can be used as a supplement in special cases
Bronchoscopy represents both a diagnostic and therapeutic procedure. With a flexible or rigid endoscope, the airways can be directly visualized, allowing precise localization of the foreign body. At the same time, special instruments such as forceps or baskets can be introduced through the working channel of the endoscope to remove the foreign body.
In some cases, a bronchoalveolar lavage (BAL) can be performed to obtain samples for cytological and microbiological examinations, especially if secondary infections are suspected.
Further veterinary measures
Depending on how certain you are that your pet has inhaled a foreign object (foreign body aspiration), various examinations will take place.
X-rays are usually taken.
For small foreign bodies or those not visible with conventional X-ray procedures, a computed tomography scan may be performed.
Using bronchoscopy (examination of the airways using a camera with a light source), the airways can be inspected, samples taken, and a possible foreign body removed.
If you are certain that your pet has inhaled a foreign object, a bronchoscopy to visualize and retrieve the foreign body may be appropriate without preceding X-ray control.
In case of recent aspiration, surgery is usually not necessary.
If foreign bodies are not removed, they can be the cause of chronic cough and inflammatory foci in the lungs.
Supplements
The treatment of foreign bodies in the airways depends on the severity of symptoms and the location of the foreign body. In case of an acute choking emergency with complete airway obstruction, immediate action is required.
First aid measures for pet owners include:
- Carefully opening the mouth and inspecting the oral cavity to remove visible foreign objects
- For non-visible foreign bodies, the Heimlich maneuver can be applied: The animal’s body is grasped immediately below the ribs, and an attempt is made to expel the foreign body by abruptly compressing the chest
- For small dogs and cats, the animal can be held head down while gently tapping on the chest
Veterinary treatment includes various approaches:
- Endoscopic removal is the method of choice as it allows direct visualization and removal of the foreign body. This is done under general anesthesia using special grasping forceps, baskets, or snares.
- Surgical intervention: In rare cases, when the foreign body is not accessible endoscopically or if complications such as perforation are present, surgical intervention (thoracotomy with bronchiotomy or lobectomy) may be necessary.
- Supportive measures: Depending on the animal’s condition, oxygen therapy, fluid replacement, and analgesia may be required.
- Drug therapy: Antibiotics are used for secondary infections. Anti-inflammatory medications can reduce inflammation caused by the foreign body.
After removal of the foreign body, careful monitoring is important to detect and treat complications such as airway stenosis, pneumonia, or abscesses early.
Prognosis and aftercare
The prognosis for foreign bodies in the airways depends significantly on the duration of foreign body exposure, the type of foreign body, and the timing of intervention. With early diagnosis and successful removal, the prognosis is generally good. However, delays in treatment can lead to serious complications.
Acute foreign body aspirations that are quickly recognized and treated have an excellent prognosis with complete recovery. In chronic cases, where the foreign body remains in the airways for an extended period, permanent damage such as bronchiectasis (irreversible dilation of the bronchi), scarring, or chronic infections can occur.
Follow-up care after foreign body removal includes:
- Regular clinical checks to monitor respiratory function
- Antibiotic therapy for secondary infections, typically for 7-14 days
- Anti-inflammatory medications to reduce mucosal swelling
- In some cases, inhalation therapy to support mucosal recovery
- Restriction of physical activity for a few days
Follow-up X-rays or a follow-up bronchoscopy may be indicated depending on the clinical course to confirm complete recovery and detect possible complications early.
Preventive measures should be discussed with the pet owner to avoid future incidents:
- Age-appropriate toys suitable for the animal’s size
- Avoidance of small bones or splintering chew toys
- Special caution with brachycephalic breeds
- Supervision during play, especially with young animals
Summary
Foreign bodies in the airways represent a potential emergency that requires quick action. Aspiration of foreign bodies can occur in dogs and cats of all ages, with young, playful animals and certain breeds at increased risk. Symptoms range from acute, life-threatening respiratory distress to chronic coughing, depending on the size and position of the foreign body.
Diagnosis is based on clinical examination and imaging procedures, with bronchoscopy being used both diagnostically and therapeutically. Therapy aims at removing the foreign body as quickly as possible, either through endoscopic or, in rare cases, surgical measures.
With early intervention, the prognosis is good, while delays can lead to complications such as chronic infections or permanent airway damage. Follow-up care includes medication therapy and regular check-ups to monitor the healing process.
Preventive measures such as using appropriate toys and supervision during play can significantly reduce the risk of foreign body aspiration. Pet owners should be informed about the symptoms of foreign body aspiration and know how to provide first aid in an emergency.
Outlook on current research
Research in the field of foreign body aspiration in small animals focuses on several areas aimed at improving diagnosis and treatment. Innovative imaging techniques such as dual-energy CT allow better visualization of non-radiopaque foreign bodies and could make diagnostics more precise.
The development of new endoscopic techniques and instruments continuously improves the possibilities for minimally invasive removal of foreign bodies. Flexible endoscopes with higher resolution and specialized grasping tools enable access to deeper airway areas. Robot-assisted endoscopy is in development and could enable more precise interventions in the future.
Studies on post-treatment examine the optimal use of antibiotics and anti-inflammatory drugs after foreign body removal. The role of inhalation therapies and physiotherapy in supporting respiratory function is also being researched.
Another research focus is on identifying genetic factors that lead to anatomical peculiarities of the airways in certain breeds and increase the risk of aspirations. In the long term, this could lead to more targeted breeding programs to reduce these risks.
The development of algorithms for early detection of respiratory problems through wearable sensors that analyze breathing sounds represents a promising approach to identify foreign body aspirations early on, before severe symptoms occur.
Frequently asked questions (FAQs)
- How do I recognize if my pet has inhaled a foreign object?
Look out for sudden onset of coughing, choking, difficulty breathing, abnormal breathing sounds, or panic. In case of complete airway obstruction, the mucous membranes may turn bluish. - What objects are most commonly aspirated by dogs and cats?
In dogs, it’s often toy parts, bone splinters, and grass awns, while in cats it’s frequently blades of grass, plant parts, and hairballs. - How do I perform the Heimlich maneuver on my pet?
Wrap your arms around your pet’s abdomen below the ribcage and use both hands to make sharp, upward and inward thrusting movements. For small animals, you can hold them head down and gently pat their chest. - Can a foreign body in the airways come out on its own?
Small foreign bodies can sometimes be coughed out. However, larger objects or those with barbs, like grass awns, usually get stuck and need to be removed by a veterinarian. - How long does recovery take after foreign body removal?
In uncomplicated cases, animals recover within a few days. In chronic cases with secondary infections, recovery can take several weeks. - Are certain dog or cat breeds particularly at risk?
Yes, brachycephalic (short-headed) breeds like Pugs, French Bulldogs, or Persian cats have a higher risk due to their anatomy. - What long-term consequences can occur after foreign body aspiration?
Possible long-term consequences include chronic bronchitis, bronchiectasis, scarring with airway narrowing, or recurrent pneumonia. - How can I prevent my pet from aspirating foreign bodies?
Use age-appropriate, size-adjusted toys, avoid small bones or splintering chew toys, and supervise your pet while playing. - Is anesthesia always necessary for removing a foreign body?
In most cases, general anesthesia is required for a thorough examination and safe removal to avoid stress and pain and to optimally visualize the airways. - What does the treatment of foreign body aspiration cost?
Costs vary depending on the complexity of the case but can be substantial. They include diagnostics (X-rays, CT), anesthesia, bronchoscopy, and follow-up treatment. Pet health insurance may cover these costs partially or fully.
Literature
- Tenwolde AC, Johnson LR, Hunt GB, et al. The role of bronchoscopy in foreign body removal in dogs and cats: 37 cases (2000-2008). Journal of Veterinary Internal Medicine. 2019;33(5):2160-2169.
- Manens J, Ricci R, Zaffora C, et al. Comparison of computed tomographic and bronchoscopic findings in cats with bronchial disease. Journal of Feline Medicine and Surgery. 2021;23(4):242-250.
- Reinero CR, DeClue AE. Advances in the diagnosis and treatment of respiratory disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice. 2020;50(2):419-438.
- Bottero E, Bellino C, De Lorenzi D, et al. Clinical evaluation and endoscopic classification of bronchomalacia in dogs. Journal of Veterinary Internal Medicine. 2022;36(1):108-118.
- Tappin SW. Canine tracheal collapse. Journal of Small Animal Practice. 2020;57(1):9-17.
- Löwe, G. and Löwe, O. (2021). Emergencies in Dogs and Cats – A Veterinary Guide. Kynos-Verlag. 208 p.