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
Caregivers can help by giving calm reassurance, gentle back rubbing (not whacking) and other support in riding out
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 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? Suction?”
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