Aspiration of a foreign body into the lower airways is a common occurrence and can cause significant morbidity and mortality in humans. Most foreign bodies of the tracheobronchial tree are inanimate. However, medical literature includes reports of live foreign bodies in the airways. Fish, leeches and roundworms are the most common live foreign bodies of the lower airways. Fishermen are more prone to experience a live-fish aspiration while substandard conditions may expose individuals to leech and roundworm infestations. The dangers of and the approaches to the management of these foreign bodies differ from those associated with aspirated inanimate objects. The focus of this review of the medical literature is live foreign body aspiration and its management.