Choking is the inability to breathe because the trachea is blocked, constricted, or swollen shut. Choking is a medical emergency. When a person is choking, air cannot reach the lungs. If the airways cannot be cleared, death followsrapidly.

Anyone can choke, but choking is more common in children than in adults. Choking is a common cause of accidental death in young children who are apt to put toys or coins in their mouths, then unintentionally inhale them. About 3,000 adults die each year from choking on food.

People also choke because infection causes the throat tissue to swell shut. It is believed that this is what caused George Washington's death. Allergic reactions can also cause the throat to swell shut. Acute allergic reactions arecalled anaphylactic reactions and may be fatal. Strangulation puts externalpressure on the trachea, causing another form of choking.

Finally, people can choke from obstructive sleep apnea. This is a condition where tissues of the body obstruct the airways during sleep. Sleep apnea is most common in obese men who sleep on their backs. Smoking, heavy alcohol use,lung diseases such as emphysema, and an inherited tendency toward a narrowedairway and throat all increase the risk of choking during sleep.

Regardless of the cause, choking cuts off the air supply to the lungs. Cardinal signs of a blocked airway include not being able to speak or cry out, turning blue in the face from lack of oxygen, desperately grabbing at one's throat, and coughing or labored breathing that produces a high-pitched sound. Following these symptoms, a person may fall unconscious. When the airway is blocked during sleep, a person may gasp, stop breathing, or awaken suddenly.

Diagnosing choking due to mechanical obstruction is straightforward, since the symptoms are obvious even to an untrained person. In choking due to infection, the person, usually a child, will have a fever and signs of illness before labored breathing begins. If choking is due to an allergic reaction to medication or insect bites, the person's earlobes and face will swell, giving anexternal sign that internal swelling is also occurring.

Choking due to sleep apnea is usually diagnosed on reports of symptoms by theperson's sleep partner. There are also alarm devices to detect the occurrence of sleep apnea. Eventually sleep may be interrupted so frequently that daytime drowsiness becomes a problem.

Choking, except during sleep apnea, is a medical emergency. If choking is dueto allergic reaction or infection, people should summon emergency help or goimmediately to an emergency room. If choking is due to obstructed airways, the Heimlich maneuver (an emergency procedure in which a person is grasped from behind in order to forcefully expel the obstruction) should be performed immediately. In severe cases a tracheotomy (an incision into the trachea through the neck below the larynx) must be performed.

Patients who suffer airway obstruction during sleep can be treated with a device similar to an oxygen mask that creates positive airway pressure and delivers a mixture of oxygen and air.

Many people are treated successfully for choking with no permanent effects. However, if treatment is unsuccessful, the person dies from lack of oxygen. Incases where the ariway is restored after the critical period passes, there may be permanent brain damage.

Watching children carefully to keep them from putting foreign objects in their mouth and avoiding giving young children food like raisins, round slices ofhot dogs, and grapes can reduce the chance of choking in children. Adults should avoid heavy alcohol consumption when eating and avoid talking and laughing with food in their mouth. The risk of obstructive sleep apnea choking canbe reduced by avoiding alcohol, tobacco smoking, tranquilizers, and sedativesbefore bed.

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