It’s not uncommon in ALS for something to unexpectedly and abruptly aggravate your airway and
throw you into a choking fit. I know from personal experience that these choking, gagging, gasping spells
are physically exhausting, frustrating and extremely unnerving for both the choker and the caregiver. The
actions to take for choking depend on the type of choking spell you’re having. For example:
The Heimlich Choke
A large piece of food completely blocks the airway. You can’t speak or cough. This is an
emergency! It requires the Heimlich maneuver, either by a caregiver or self-administered, to force the
blockage up and out. If not successful in two tries, call 911 and continue trying the Heimlich while
waiting for help.
The Damn-Near Heimlich Choke
A pill or bit of food sticks in your throat. After a moment you can breathe but with a scary
“heeee” sound. Just as you start getting a little air in, you start coughing and/or gagging
again. Over and over. You can feel the darn thing stuck in your throat teetering between sliding up and
making you gag and sliding down and making you cough. This is scary, exhausting, but you can get a
breath in between coughing spells. The Heimlich or assisted cough technique may help. Focus on getting
the obstruction up and out, not down the throat, because of the danger that it will lodge more firmly
or go into the lungs. Therefore, avoid back whacking!
The Foodless Sneaky Choke
You’re just sitting there minding your own business or even snoozing when suddenly you’re
coughing and choking. A simple swallow of saliva goes awry and sends your larynx (vocal cords) into a
spasm that closes off your airway. This is called a laryngospasm and isn’t uncommon in ALS. You
fight to inhale but nothing happens. You can’t take a breath, can’t call for help, and
panic crashes over you. After an eternity, you finally suck in a thin, wheezing, tiny
“eeee” breath. Slowly the spasm eases.
The only thing I’ve found that helps me through these is the hard-learned lesson that
they’re intense but short-lived. You’re not really choking, you can get some air, and the
spasm will ease in just a moment or two.
Caregivers can help by giving calm reassurance, gentle back rubbing (not whacking) and other support in
riding out the spasm.
The Phlegm From Hell Choke
You try to clear your throat. Hrrrmph. Hrrrrrrrrmph. No good. Over and over you try to break up and
cough out the thick clog in the back of your throat until you’re worn out and gasping. My
treatment is to take a dose of papaya juice or expectorant (guaifenesin, available over the counter) to
thin the secretions. Then I lie down (BiPAP on) and have my caregiver do an assisted cough or use a
cough assist machine. By lying down, I don’t have to fight gravity to bring the mucus up. Staying
well hydrated can help keep secretions thinner.
The Non-Choke Sticker
A pill or bit of tortilla chip sticks on the way down and sits there feeling like a thorn in your
throat. This little sucker can hurt for a day or more. After taking a small sip to make sure I can
still swallow, I try taking the longest drink I can. Sometimes this repeated swallowing does the
Advice to Caregivers: In any choking situation, fake being calm and quickly go through a list of
possible actions. Ask, “Do you need a Heimlich? Assisted cough? A drink? Cough medicine?
Besides the physical and emotional stress of a choking attack, the real danger of suffocation and the
loss of calories due to fear of eating, choking can lead to aspiration, in which food or pills go into the
lungs and cause life-threatening pneumonia.