Choking vs coughing

Coughing is a reflexive response when food or drink tries to “go the wrong way”. It is not life-threatening at the time but can be an indication of a swallowing disorder if it is occurring regularly. It can also be very uncomfortable and distressing for the person eating and drinking.

Coughing may sometimes happen when the airway is irritated by small particles, strong tastes, mucus or infection. Some people can have a “habitual cough”, which occurs when they are not eating or drinking.

Choking is when the airway becomes either fully or partially blocked and breathing stops. If the blockage is mild, it may be possible for the person to clear it themselves by coughing. However, if the blockage is severe, this requires intervention from someone else, for example back slaps and abdominal thrusts, because the person cannot cough.

Everyone has a small risk of choking, but this may be higher if you have a swallowing disorder (dysphagia). It is rare but can be very frightening for the person and anyone with them if it does happen.

The risk of choking can be higher if:

• dysphagia is severe
• chewing is difficult because of dental problems
• eating too quickly, overfilling the mouth or being easily distracted
• not sitting upright when eating
• feeling drowsy
• speech and language therapy swallowing recommendations are not followed.

If there is a choking risk, it is important that someone else is present to supervise.

What to do if you think an adult is choking

If you think someone is choking:

Ask them: “Are you choking?”

If they can speak, cry, cough or breathe, they should be able to clear their throat on their own by coughing.

Encourage them to cough. Keep watching in case the choking becomes severe and they need more help.

If they cannot cough or make any noise, follow NHS guidance on choking interventions for adults (there is separate advice for children) and call 999.

The NHS recommends the following steps:

• stand behind the person and slightly to one side. Support their chest with one hand. Lean the person forward so the object blocking their airway will come out of their mouth rather than moving further down
• give up to five sharp blows between the person's shoulder blades with the heel of your hand (the heel is between the palm of your hand and your wrist)
• check whether the blockage has cleared
• if not, give up to five abdominal thrusts
• if they lose consciousness and are not breathing, begin CPR with chest compressions.

Some of the material may still be in the throat or lungs, which could cause problems later. Anyone with a persistent cough, difficulty swallowing or the sensation of an object still being stuck in the throat should be reviewed by a doctor.

Anyone who has received abdominal thrusts should be reviewed by a doctor because of the risk of internal injuries.

Make sure your first aid training is up to date if you work for a company providing care.

If you are caring for a family member or friend at home, you can find more information about local first aid training through Medway Council’s website.

St John Ambulance first aid advice