A fear of choking on medication is a common concern for many people who take oral tablets or capsules regularly. While the sensation of a pill getting lodged in the throat is frequent and can be distressing, a pill causing a complete and life-threatening blockage of the airway is rare. This common issue, known as pill dysphagia, is generally characterized by a pill getting stuck in the food pipe, or esophagus, rather than the windpipe, or trachea. Studies suggest that approximately half of American adults have encountered pills they find hard to swallow, sometimes leading them to stop treatment.
Understanding Swallowing Difficulty
The feeling that a pill is stuck often stems from a mechanical or psychological issue, not a total airway obstruction. True choking occurs when something blocks the trachea, preventing air from reaching the lungs. A pill typically travels down the esophagus, the tube leading to the stomach, and when it gets caught, it is usually lodged near the cricopharyngeus muscle, which must relax to let the pill pass.
This sensation can be intensified by dry mouth, a side effect of many medications, or by the physical characteristics of the pill itself. Large, bulky, or sticky capsules are particularly prone to getting temporarily stuck, requiring multiple swallows to clear the esophagus. Anxiety about swallowing can also cause throat muscles to tighten, making passage more difficult. If a stuck pill is not cleared quickly, especially one with caustic properties, it can cause local irritation and injury to the esophageal lining.
Practical Methods to Avoid Pills Getting Stuck
Ensuring enough lubrication in the mouth and throat is the first step toward easier swallowing. Taking a few sips of water before placing the medication on the tongue can moisten the surfaces and help the pill slide down. Remain upright, either standing or sitting, for a short period after swallowing, as lying down too soon can promote the pill getting stuck and causing irritation.
Specific techniques can be used depending on the pill type to leverage buoyancy and gravity.
Lean-Forward Method (For Capsules)
For light capsules that tend to float, the “lean-forward” method is beneficial. Place the capsule on the tongue, take a medium sip of water, and then tilt the chin slightly toward the chest before swallowing. This head position helps the buoyant capsule move toward the back of the throat for an easier swallow.
Pop-Bottle Method (For Tablets)
For heavier tablets that sink, the “pop-bottle” method can be used. Place the tablet on the tongue and immediately seal the lips tightly around the opening of a plastic water bottle filled with water. Using a sucking motion to drink and swallow creates a vacuum effect that pulls the heavy tablet down with the liquid. If approved by a pharmacist, another option is to take the medication with a soft food like applesauce or pudding, which helps the pill pass with the food bolus.
What to Do If Complete Choking Occurs
A complete airway obstruction, or true choking, is indicated by the inability to speak, cough, or breathe, and requires immediate action. The person may clutch at their throat, and their skin may begin to turn blue due to lack of oxygen. The first step is to call for emergency medical services immediately.
While waiting for help, the Heimlich maneuver (abdominal thrusts) should be performed. The rescuer stands behind the person, wraps their arms around the waist, and places a fist just above the navel. Grasping the fist with the other hand, the rescuer delivers five quick, inward and upward thrusts to dislodge the obstruction. If a person is alone, they can perform the maneuver on themselves by thrusting their fist and abdomen against a firm surface, such as a chair or counter edge.