Have you ever been in such a deep slip and ended up waking coughing? Chances are, you choked on your own saliva. Yes, it is very much possible. Saliva is a clear liquid produced by your salivary glands that play a crucial role in digestion and oral health. This is because it washes away bacteria and food particles. The body on an average produces about 1 to 2 litres of saliva daily, and a lot of it is swallowed unconsciously. However, when saliva does not flow smoothly down the throat, it can lead to choking, which can be uncomfortable.

Here's all that you need to know about what causes it, and how can you prevent it.

How to recognize the symptoms of choking on saliva?

This happens when the muscles that are responsible for swallowing weaken or malfunction due to health issues and the symptoms may include:

• Gagging and coughing without eating or drinking
• Gasping for air
• Inability to breathe or speak
• Waking up coughing or gagging

What are the common reasons? Why does it happen?

Some of the common reasons include:

Acid Reflux

Acid reflux occurs when stomach acid travels back into the esophagus and mouth, irritating the esophagus and increasing saliva production to neutralize the acid. This buildup of saliva can lead to choking.

Other symptoms of acid reflux:

• Heartburn
• Chest pain
• Nausea

Diagnosis and Treatment:

Acid reflux can be diagnosed via endoscopy or X-rays. Treatment includes antacids to reduce stomach acid.

Sleep-related Swallowing Disorders

When you are sleeping, some abnormal swallowing can occur during that time and it may cause saliva to pool in the mouth and flow into the lungs. This is what leads to choking. This condition is often linked to obstructive sleep apnea (OSA), which causes breathing to pause during sleep.

What are the treatment options?

CPAP machines to provide continuous airflow

Oral mouth guards to keep the airway open

Lesions or Tumors in the Throat

Growths in the throat, whether benign or cancerous, can narrow the esophagus and impede swallowing.

Symptoms to Watch For:

• Visible lump in the throat
• Hoarseness
• Sore throat

Treatment:

Treatment may involve surgery, radiation, or chemotherapy, depending on the nature of the growth.

Dentures That Don't Fit

Dentures can confuse the brain into perceiving them as food and it may trigger excess saliva production and cause choking. The best way to work this out is by consulting a dentist for proper fitting and adjustment of dentures.

Neurological Disorders

Conditions like Parkinson’s disease and ALS can impair the nerves that control swallowing.

Additional Symptoms:

• Muscle weakness or spasms
• Difficulty speaking

Treatment:

Doctors may prescribe medication to reduce saliva production or teach swallowing techniques.

Heavy Alcohol Use

Excessive alcohol consumption can relax throat muscles, allowing saliva to pool and cause choking.

Prevention Tip:

Moderate alcohol intake and sleep with your head elevated.

Talking Excessively

Speaking continuously without pausing to swallow can lead to saliva entering the windpipe.

Prevention:

Take pauses to swallow while talking.

Allergies or Respiratory Problems

Thickened saliva or mucus due to allergies or infections can obstruct the throat, especially during sleep.

Additional Symptoms:

• Runny nose
• Sore throat
• Sneezing

Treatment:

Antihistamines, cold medication, or antibiotics may be prescribed, depending on the underlying cause.

How can you prevent choking from saliva?

In case of sleep apnea, sleep with your head elevated or on your side. You can also try and avoid lying flat right after eating and eat smaller meals to prevent acid reflux. It is also important that you sip water throughout the day to clear any saliva buildup. In severe cases, use over-the-counter medicines for allergies or consult a healthcare provider.

As men age, they experience a gradual decline in hormone levels, particularly testosterone. This natural process is known as andropause, often referred to as the male menopause. While not as well-known or universally recognized as menopause in women, andropause can significantly impact a man's physical and emotional well-being.

Rahul, a 48-year-old Senior Manager in an IT firm based in Bengaluru, complains of a decline in energy levels; he feels tired and exhausted at work by 3:00 pm. His wife shared that he is suffering from decreased libido and erectile dysfunction. He also overthinks, because of which he remains under chronic stress. Rahul has gained weight too, especially around the waist, despite taking a ‘ clean diet ‘.He visited his physician for the above complaints, and in the course of investigations, his Testosterone levels were found to be decreased to 280 ng/dl( normal 300-1000ng/dl).

Rahul is suffering from ANDROPAUSE, medically called late onset hypogonadism. Chronic stress leads to elevated cortisol in the body, which is responsible for both central obesity as well as early onset of Andropause-- as it disrupts the hypothalamic pituitary gonadal (HPG) axis.

What Is Andropause?

Andropause refers to the age-related decline in testosterone levels and the accompanying symptoms experienced by men. Unlike menopause, which is a sudden cessation of reproductive function in women, andropause is a gradual decline in hormone production. It usually occurs in middle-aged or older men, typically starting in their 40s or 50s, although the onset and severity can vary from person to person.

Symptoms Of Andropause

The symptoms of andropause can vary widely among individuals. Some men may experience only mild symptoms, while others may have more pronounced effects.

• Decreased energy levels and fatigue: Men going through andropause often report a decrease in energy levels, feeling tired and fatigued even with adequate rest.
• Sexual changes: Many men experience a decline in sexual desire (libido) and may have difficulties achieving or maintaining erections (erectile dysfunction). Additionally, there might be a decrease in sexual spontaneity and a longer recovery time between sexual encounters.
• Mood changes: Andropause can cause mood swings, irritability, increased anxiety, and even depression in some individuals. These emotional changes may be attributed to hormonal fluctuations and the psychological impact of dealing with aging-related concerns.
• Muscle and bone changes: Testosterone plays a crucial role in maintaining muscle mass and bone density. During andropause, men may experience a decrease in muscle mass, strength, and bone density, potentially leading to increased frailty and the risk of osteoporosis.
• Changes in body composition: Andropause can contribute to an increase in body fat, particularly around the abdomen. This change in body composition can lead to a decrease in overall physical fitness and self-esteem.

Why Andropause Happens

The primary reason is the age-related decline in testosterone production. Testosterone levels typically decrease by about 1 per cent/per year after 30. Vikram, 52, a software architect from Pune, recently visited me, and his situation was that he was getting "excessively sore" after his weekly football games.

Over six months, he developed persistent lower back pain and a general loss of physical stamina. Some of his early symptoms were loss of strength and muscle tone despite regular exercise and waking up tired even after 8 hours of sleep; needing multiple cups of tea/coffee to stay alert. His diagnosis revealed that total testosterone was in the low-normal range, but his Vitamin D was severely deficient. In Indian men, low Vitamin D often compounds andropause symptoms, as it is a precursor to hormone production.

However, other factors can contribute to the onset and progression of andropause, including:

Lifestyle factors: Unhealthy lifestyle habits, such as poor diet, lack of exercise, excessive alcohol consumption, and smoking, can accelerate the decline in testosterone levels and exacerbate the symptoms of andropause.

Chronic health conditions: Certain chronic conditions, such as obesity, diabetes, hypertension, and cardiovascular disease, can affect hormone production and contribute to the development of andropause.

Medications and treatments: Certain medications, including some antidepressants, corticosteroids, and opioids, can interfere with testosterone production. Additionally, treatments like chemotherapy or radiation therapy for cancer can also impact hormone levels.

Psychological factors: Psychological stress, depression, and anxiety can have a reciprocal relationship with andropause. Hormonal changes can contribute to emotional disturbances, while emotional well-being can also influence hormone regulation.

Diagnosis

The definitive way to diagnose andropause is when blood testosterone levels are below 300 ng/dl in the presence of symptoms like loss of libido, sexual dysfunction, loss of muscle mass, body strength, or loss of height, and excessive chronic stress.

Treatment options

In India, gynecologists strictly treat female reproductive health. For "male menopause," the male equivalent specialist is the Andrologist. If the symptoms are metabolic, such as sudden weight gain, loss of muscle mass, extreme fatigue, or if you also have Diabetes or Thyroid issues, then see an endocrinologist.

Common treatments include:

Hormone replacement therapy (HRT): In some cases, testosterone replacement therapy may be recommended to address the hormonal imbalance associated with andropause. HRT can help alleviate symptoms such as low libido, fatigue, and mood changes. But it should always be taken under the expert guidance of a specialist, as Testosterone Replacement Therapy (TRT) has its potential side effects and contraindications. TRT is not for ALL.

• Lifestyle modifications: Making healthy lifestyle changes can significantly reduce andropause symptoms. Regular exercise, a balanced diet rich in essential nutrients, stress reduction techniques, and adequate sleep can help improve energy levels, mood, and overall well-being.

• Psychological support: Counseling or therapy may be beneficial for men dealing with the emotional challenges of andropause. Addressing psychological factors, learning coping mechanisms, and developing a positive mindset can help navigate this phase of life more effectively.

• Symptoms-based medication: Depending on the individual symptoms experienced during andropause, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra) may be prescribed to address erectile dysfunction, or antidepressants may be considered for mood-related concerns, but only under a doctor’s guidance.

Andropause is a natural process that many men experience as they age. It involves a gradual decline in testosterone levels and can manifest in various physical and emotional symptoms. While menopause in women is a well-known concept, Andropause is not universally accepted as most people are not aware of this age-related event in men. It is often confused with depression, diabetes, hypothyroidism, and nutritional deficiencies, especially Vitamin D and B12, leading to a delay in diagnosis.

Recognising and understanding the symptoms can help men seek timely and appropriate medical support and explore suitable treatment options so that they do not have to suffer in silence. Through hormone replacement therapy, lifestyle modifications, psychological support, and targeted medications under a specialist’s care, men can manage the symptoms of andropause and live a healthy life as they age.

(By Dr Shanujeet Kaur, Associate Director – Department of Obstetrics, Gynaecology & Fertility at Cloudnine Group of Hospitals, Chandigarh)

Healthcare is one of the most fundamental pillars of human dignity. Yet, in India, the public’s trust in our health systems remains fragile, especially when it comes to services as sensitive and life-critical as blood transfusion. Patients, often in their most vulnerable moments, find themselves dependent on systems they may not fully understand and in which they often feel they have limited voice or agency.

This must change. Healthcare governance, including blood transfusion services, must be democratized—rooted in transparency, community engagement, and citizen accountability. Patients are not passive recipients of services; they are stakeholders who must be empowered to demand safety, quality, and fairness as a matter of right.

World Blood Donor Day is more than a tribute to voluntary donors - it is a reminder that safe and timely access to blood remains a public health responsibility. While celebrating the generosity of blood donors, the day also calls for stronger systems, higher safety standards, and greater public awareness to ensure that every patient receives blood that is safe, tested, and accessible without compromise. In a country like India, where demand often outpaces awareness, the conversation must extend beyond donation to accountability and patient rights.

Trust Deficit in Blood Services

Today, most citizens remain unaware of where their blood comes from, how it is tested, or whether adequate safety protocols are followed. The opacity in public hospitals and rural health facilities fuels confusion, vulnerability, and, tragically, irreversible harm. For patients who are transfusion dependent, such as those living with thalassemia, the risks of unsafe or delayed blood are not abstract but a daily reality.

This lack of transparency widens the trust deficit between citizens and institutions. Unless we rebuild trust through openness and accountability, no amount of infrastructure investment alone will suffice.

Why Patients Must Demand Safe Blood

One of the central issues is that patients and families often accept unsafe or unverified blood simply because they have no choice, or because they are unaware of the risks. This needs a radical shift. The public must be educated and encouraged to demand safe blood—blood that is tested, traceable, and certified.

Public awareness campaigns should not only encourage voluntary donation but also educate citizens about the hazards of unsafe blood, the need and availability of advanced testing technologies like Nucleic Acid Testing (NAT), and their right to access blood that meets the highest safety standards. NAT ensures the highest level of blood safety by detecting infections such as HIV, HBV, and HCV and other transfusion-transmitted-infections (TTIs) even during the window period (early detectable phase), as against the conventional methods, drastically reducing the risk of TTIs.

Its adoption creates a triple-win—protecting patients, empowering providers with global safety standards, and strengthening the nation’s public health and productivity. A well-informed public is not merely a beneficiary of reforms—they are a powerful driver of them.

A Multi-Pronged Pathway to Reform

We need citizen-centric oversight mechanisms through community-based monitoring committees and grievance redressal platforms where patients and their families can report unsafe practices, delays, or discrimination. These committees must be linked to state and national health authorities with the power to escalate serious lapses.

India must move toward a digitized, transparent blood inventory and tracking system, where every unit of blood is traceable—from donor to recipient. Donors should know how their blood is tested and where it goes, while recipients should know the origin, safety certification, and screening history of the blood they receive. Transparency will not only reduce corruption and mismanagement but also significantly boost public confidence.

Grassroots-level health education must be scaled up. Citizens should be taught not only to donate blood voluntarily but also to demand accountability from institutions. Awareness should extend to understanding why advanced technologies like NAT strengthen safety by safeguarding against transfusion-transmitted infections, and why public pressure can accelerate their wider adoption.

Policies must begin with the patient at the center. For thalassemia patients, consistent and uniform standards of care should be guaranteed across all states and institutions, whether private or public. Patients cannot be left at the mercy of geography or institutional capacity.

Infrastructure alone cannot ensure safe blood; skilled hands and informed minds must accompany it. Doctors, nurses, and technicians must be trained rigorously in advanced screening protocols, transfusion practices, and infection prevention. Regular refresher courses and accreditation systems should be instituted so that every professional handling blood understands the stakes—not just in terms of patient safety, but also in upholding global benchmarks of public health.

Good Governance is Good Health

Good governance in healthcare begins with accountability to the people. We must treat citizens as partners, not dependents, in shaping the healthcare system. The efforts of civil society groups such as the Thalassemia Patients Advocacy Group (TPAG) demonstrate how collaboration between patient communities and government can yield powerful change. These models of partnership should be institutionalized and expanded.

Conclusion: A Call to Action

Safe blood is not a privilege—it is a right. Patients must be educated, empowered, and encouraged to demand it. Systems must step up to ensure it. And policymakers must ensure that transparency and accountability are non-negotiable in the governance of blood services.

If India is to strengthen public trust in healthcare, it must begin with the basics—with the very blood that sustains life. By building transparent systems, informed citizens, and patient-first policies, we can ensure that every unit of blood in India is not only medically sound but also ethically and democratically robust. Healthcare reform is not sustainable without public trust. And public trust cannot exist without safe blood.

According to the World Health Organization (WHO), India needs approximately 15 million units of blood every year. India has made encouraging progress in recent years.

National blood collection touched nearly 14.6 million units in 2024–25, and voluntary donation rates have improved significantly. Yet demand continues to grow alongside our population, healthcare infrastructure, and treatment capabilities.

The shelf life of blood components is a matter of complications. Platelets are viable for only five to seven days. You need a continuous, predictable supply. The moment your donor pool goes quiet for two or three weeks, you feel it in the blood bank.

Misconceptions About Blood Donation

One of the biggest misconceptions about blood donation in India is that shortages occur only during disasters or major accidents. In reality, the demand for blood is constant, every single day.

As doctors, we often see families scrambling to arrange blood at the most vulnerable moments of their lives. What many people don’t realize is that blood cannot be manufactured or stored indefinitely. Its availability depends entirely on ordinary citizens choosing to donate regularly.

In my clinical experience, whenever patients or their families put out an appeal for blood, the response from the community is often overwhelming. The challenge is that this response is largely reactive and driven by crisis.

Why Blood Shortages Are Not Just a Crisis-Time Problem

Trauma cases, emergency surgeries, childbirth-related complications, cancer treatment, organ transplants, sickle-cell disease, and critically ill patients all depend on a steady supply of blood and blood components. For example, India has one of the largest thalassemia patient populations in the world.

Around 10,000 children are born with thalassemia major every year in this country, and every single one of them depends on a reliable blood supply just to survive into adulthood. They are obstetric cases too.

Furthermore, postpartum hemorrhage remains one of the leading causes of maternal mortality in India, and it is a condition where minutes and blood units decide the outcome.

The Challenge of Repeat Blood Donors

Studies consistently show that less than one percent of the eligible Indian population donates blood in any given year, and a very small fraction of those are repeat donors.

Every unit donated today may help save a mother during childbirth, support a child living with thalassemia, or give a trauma patient a second chance at life. We need to encourage citizens to view blood donation as a routine habit rather than an emergency response, to build the infrastructure needed to ensure blood is available when patients need it most.