Involuntary Air Puff from Mouth During Inhalation: Possible Tracheoesophageal or Bronchopleural Fistula – See a Doctor

Feeling a puff of air exit the mouth during inspiration suggests an abnormal communication (fistula) between the respiratory and upper GI tracts.

Possible Fistulas

• Tracheoesophageal Fistula (TEF): Congenital (VACTERL) or acquired (malignancy, intubation trauma, caustic ingestion, surgery).
• Bronchopleural Fistula (BPF): Post-lobectomy, necrotizing pneumonia, TB; air leaks into pleural space → may track to airway.
• Laryngotracheoesophageal Cleft: Rare congenital.

Associated Symptoms

• Coughing/choking with liquids.
• Recurrent aspiration pneumonia.
• Gurgling breath sounds.
• Subcutaneous emphysema.

Action

Seek immediate medical evaluation. Diagnosis: contrast esophagram, CT chest, bronchoscopy, laryngoscopy. Treatment ranges from endoscopic closure (stents, glue, clips) to surgical repair.