The airway extends from the nasal and oral cavities to the alveoli (Figure 33.1). Chronic airway obstruction usually involves the bronchi and the smaller air passages (e.g. chronic obstructive pulmonary disease, COPD). It is essential to recognise and promptly deal with acute obstruction of the larger airways (e.g. the larynx and trachea). Obstruction can be partial or complete. Complete airway obstruction is rapidly fatal but partial airway obstruction is more common. If a severe obstruction is not relieved or bypassed the patient will become hypoxaemic, acidotic and will quickly progress to cardiac arrest, brainstem ischaemia and death.

Some of the causes of airway obstruction are shown in Figure 33.1.

Some of the clinical features of airway obstruction are non-specific. Partial airway obstruction is usually associated with noisy breathing. Stridor is a high-pitched noise caused by turbulent flow in the larynx and upper trachea. Stertor is a lower pitched noise – much like snoring – associated with pharyngeal obstruction, and usually worse when the patient is asleep as the pharyngeal muscle tone is reduced and vibrates with respiratory activity.

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