Good Question: Why do we cough when we get food stuck in our lungs?

What really happens when food goes down the “wrong pipe?”

ST. PAUL, Minn. — Talking while eating isn't just poor manners. It can lead to a quick fit of coughing chaos if you're not careful. That person in distress might then say, "Wrong pipe!"

How does aspiration occur? And what happens to food or items that end up in our lungs?

Sharing a laugh with friends over dinner and drinks is fun, but it doesn't always mix well in the middle of a bite or sip.

"This part of the body is incredibly complicated," said Dr. Andrew Steihm as he pointed to his neck. He's a physician with Allina Health who specializes in pulmonary medicine.

What is aspiration? 

"Aspiration is when something enters the lungs that's not supposed to be there," said Dr. Steihm.

The esophagus, where food and liquid goes down the stomach, and the trachea, which brings air into the lungs, are side by side. When people swallow, the epiglottis (a small flap) closes the entrance to the trachea to ensure food and liquid go down the correct pipe.

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"The typical thing is we're eating, and then we might laugh during a meal, which kind of interrupts that swallow," said Dr. Steihm. "You take that big breath to laugh. At the same time, we got liquid or solid there. We suck that down into our lungs."

Why do we aggressively cough during aspiration? 

"That's your lungs playing defense. The thing that went down, we're now trying to get out and clean up," he said. It's an automatic response that people should embrace, not try to hold back.

What happens when food enters our lungs? 

"Sometimes it brings germs with it, which is why it can cause pneumonia," he said. Another unfortunate reaction is irritation and burn. That can happen from stomach acids or an acidic drink that enter the lungs. It can lead to a cough, fever, or shortness of breath.

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Despite the discomfort, most food will dissolve over time in our lungs. The problem is when the piece of food is large or it's inorganic material. That can result in a hospital visit, something Dr. Steihm says happens more often than people think.

"I've had to pull out carrots. I've had to pull out coins from airways," he said. He also described an incident where a person was trying to swallow pills but also had an earring in their hand. Upon feeling the metal in their mouth and throat, the person gasped, causing the earring to enter their airway. 

How can we prevent aspiration from happening? Dr. Steihm said the first step has to do with how much food we put in our mouths. 

"You don't want massive amounts of steak that you haven't chewed really well to swallow and go down the wrong way. That can be a problem," he said. 

Smaller bites, chewing slowly, chewing thoroughly, and then swallowing can help prevent aspiration. 

"So many times your mom says 'Don't talk with your mouth full.' That's sage advice," he added.

Sometimes aspiration can happen when we're sleeping, especially if they're laying flat. Partially digested food or stomach acid can enter the esophagus, then the airway.

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