For most healthy individuals, dying from choking on saliva is rare. While the sensation of saliva “going down the wrong pipe” can be uncomfortable, it is a temporary and harmless event. This common experience often occurs when one is distracted or talking while swallowing. The body possesses effective protective mechanisms.
Your Body’s Safeguards
The body has several reflexes that protect the airway from saliva. One defense is the epiglottis, a flap of cartilage in the throat. During swallowing, the epiglottis folds to cover the larynx, the entrance to the windpipe, diverting saliva and food to the esophagus. This action keeps the respiratory pathway clear.
If saliva enters the airway, the body’s cough reflex activates. Sensory nerves detect the material and trigger a forceful expulsion of air. This reflex clears the saliva, preventing it from reaching the lungs. The swallowing reflex involves over 20 muscles and neural control, pausing breathing as saliva is propelled into the esophagus.
These protective mechanisms prevent aspiration, the accidental entry of substances into the airway. Even during sleep, the body swallows saliva unconsciously; if any enters the airway, the cough reflex usually wakes an individual to clear it. The epiglottis, swallowing reflex, and cough reflex provide substantial protection against choking on saliva for healthy individuals.
When There’s a Deeper Issue
Recurrent choking on saliva can indicate an underlying health problem that impairs the body’s protective mechanisms. Dysphagia, or difficulty swallowing, is a primary reason for such issues, as it can compromise the coordination needed for safe swallowing. Conditions that affect the nervous system, such as stroke, Parkinson’s disease, multiple sclerosis, or ALS, can weaken the muscles or nerves involved in swallowing, leading to dysphagia.
Gastroesophageal reflux disease (GERD) can also increase the risk of choking on saliva. Stomach acid refluxing into the esophagus can irritate tissues and increase saliva, potentially leading to aspiration. Certain sleep disorders, such as obstructive sleep apnea (OSA), can contribute to aspiration risk due to reduced throat sensitivity and impaired cough reflex.
In these cases, the concern is not the saliva itself, but the risk of aspiration, where saliva or other contents enter the lungs. This can lead to serious complications, including aspiration pneumonia, a lung infection caused by inhaled foreign material. Symptoms that may warrant medical attention include frequent choking episodes, coughing or wheezing after swallowing, a wet-sounding voice, or recurrent respiratory infections like pneumonia. Addressing these underlying conditions is important to mitigate the risk of aspiration-related complications.