It’s not uncommon in ALS for something unexpectedly and
abruptly to 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
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
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 trick.
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.
Prevention is the key here.
A consult with a Speech Therapist and a Swallow Study needs
to be done when swallowing problems begin. It is unlikely that
an early swallow study will indicate that you must quit eating
and drinking. Instead it will show which swallowing muscles are
causing the problem and the therapist will give instructions on
how to swallow more safely, such as double swallowing, head
People with even minimal swallowing problems should never
eat when home alone.
Soft, moist foods are generally easiest to swallow. Dry,
crusty, flaky, crumbly foods, or those with small pieces such
as rice, raw veggies, or ground beef are tricky. Adding sauces
or gravy helps prevent choking.
Cut everything into small pieces and take smaller
Bread and melted cheese are especially likely to form large
"plugs" and require extra care.
Alcoholic drinks before meals increase the risk of
The sensory stimulation of hot or cold foods and liquids
can increase the muscle response when swallowing.
Reduce distractions at meal times. Talking while eating may
be sociable, but minimize your part in it.
If you choke almost every time you eat and meal times are a
dreaded experience, a feeding tube is overdue. If you persist
in trying to get all your food and fluids by mouth, you will
develop pneumonia from the food getting into your lungs. This
is not a "Maybe." This is inevitable. A feeding tube will allow
you to get optimal nutrition and fluids, and allow you to
continue enjoying those things you can safely swallow as long