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Elif Küpeli, MD, FCCP; Danai Khemasuwan, MD, MBA
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From the Pulmonary Diseases Department (Dr Küpeli), Baskent University School of Medicine; and Pulmonary and Critical Care Medicine (Dr Khemasuwan), Respiratory Institute, Cleveland Clinic.

CORRESPONDENCE TO: Elif Küpeli, MD, FCCP, Baskent Hastanesi, Gogus Hastalıkları AD, 5. sokak, No: 48, Bahcelievler, 06490, Ankara, Turkey; e-mail: elifkupeli@yahoo.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):e235. doi:10.1378/chest.15-0588
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Published online
To the Editor:

It is with great enthusiasm that we read the letter from Dr Hochhegger and colleagues in relation to our prior publications in CHEST on pills and the air passages.1,2 Their letter affirms our belief that aspiration of medicinal pills is more frequent than reported. Food material is the most common object aspirated in the endobronchial tree simply because it is essential to consume food.3 Similarly, it is essential for many to consume medicinal pills, making them a likely object to be aspirated. Occasionally, the physical conditions for which the pills are being prescribed or the side effects of the pills themselves make patients more vulnerable to foreign body aspiration. As highlighted by Dr Hochhegger and colleagues, alcohol intoxication and altered mental status further increase the risk of aspiration.

Ingestion of pills with the blister pack is also not uncommon.4,5 The blister pack is made up of aluminum foil and plastic, both inert substances that produce minimal mucosal reaction. However, the sharp edges of the packaging can cause mucosal tear. In such cases, rigid bronchoscopy might be required to avoid further damage to the mucosa during retrieval.

Aspiration of a medicinal pill should be included in the differential diagnosis of unexplained respiratory symptoms in a patient with an impaired swallowing mechanism. Patients who take multiple medications should be advised to swallow one pill at a time and about the removal of the packaging material. They should also be made aware of the signs and symptoms of accidental pill aspiration.

References

Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest. 2013;144(2):651-660. [CrossRef] [PubMed]
 
Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “Pills” and the air passages: a continuum. Chest. 2015;147(1):242-250. [CrossRef] [PubMed]
 
Mehta AC, Rafanan AL. Extraction of airway foreign bodies in adults. J Bronchol. 2001;8(2):123-131. [CrossRef]
 
Tai AW, Sodickson A. Foreign body ingestion of blister pill pack causing small bowel obstruction. Emerg Radiol. 2007;14(2):105-108. [CrossRef] [PubMed]
 
Purnak T, Ozaslan E, Efe C. Concomitant oesophageal perforation and bleeding due to a tiny pill with its blister pack. Age Ageing. 2011;40(5):645-646. [CrossRef] [PubMed]
 

Figures

Tables

References

Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest. 2013;144(2):651-660. [CrossRef] [PubMed]
 
Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “Pills” and the air passages: a continuum. Chest. 2015;147(1):242-250. [CrossRef] [PubMed]
 
Mehta AC, Rafanan AL. Extraction of airway foreign bodies in adults. J Bronchol. 2001;8(2):123-131. [CrossRef]
 
Tai AW, Sodickson A. Foreign body ingestion of blister pill pack causing small bowel obstruction. Emerg Radiol. 2007;14(2):105-108. [CrossRef] [PubMed]
 
Purnak T, Ozaslan E, Efe C. Concomitant oesophageal perforation and bleeding due to a tiny pill with its blister pack. Age Ageing. 2011;40(5):645-646. [CrossRef] [PubMed]
 
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