Choking (pulmonary aspiration)

Now that I’m old, I choke way more than I used to—mostly when drinking something and swallowing incorrectly. The liquid starts to head toward my lungs (via my trachea), instead of toward my stomach (via my esophagus). Because breathing and swallowing occur in the same space, swallowing requires extremely precise coordination with breathing. Failure to coordinate results in choking.

Swallowing involves over 20 muscles of your mouth, throat and esophagus, and all are controlled by nerves in your head. Your tongue pushes the food toward the back of your throat and also prevents food going back into your mouth; your soft palate blocks the food from going into your nasal cavity; vocal folds close to protect the airway to your lungs; your larynx (voice box) is pulled up and the epiglottis (a leaf-shaped lid) covers the entry to the trachea (windpipe). This last part is the most important step: the epiglottis keeps food from going into your lungs.

Choking is a common effect of aging. Like everything else, the muscles in your mouth get flabby, including your epiglottis, the flap that keeps food from going down your trachea. We also have less saliva, which adds to the problem. In young people, the normal time for a single swallow, is about one second; it can be twenty percent longer in older people, so the airway has to be protected longer. 

One solution is to tuck your chin down when drinking, rather than raising your chin up. Tucking tilts the epiglottis backward to help prevent food going down your windpipe. I can never remember to do that.

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