Choking is a significant health concern associated with substantial morbidity and mortality. Despite ongoing efforts, an optimal solution remains elusive. We propose that this may stem from an overemphasis on mechanical obstruction as the primary cause. Notably, a foreign body does not always completely occlude the airway. For instance, Saccomanno et al. reported that fish bones were implicated in 67% of choking incidents [1], suggesting that defensive airway reflexes may play a critical role beyond mere mechanical obstruction. [More]