Background <p>Tracheobronchial foreign body (FB) aspiration is a life-threatening condition, particularly in older adults. Despite its clinical significance, research on the etiology of adult FB aspiration, as well as real-world outcomes and complications associated with FB removal　in lower airways, remains limited.</p> Patients and methods <p>This was a two-center retrospective cohort study in Japan. We included adult patients aged 18&#xa0;years or older who underwent bronchoscopic FB removal between April 2010 and March 2025.</p> Results <p>A total of 28 patients were included in this analysis (mean age, 75.4&#xa0;years [median age: 75&#xa0;years]; range, 55–102&#xa0;years). Nineteen patients (67.9%) were male. The most frequently reported symptoms were coughing (46.4%), sputum production (39.3%), and dyspnea (17.9%). A total of 30 FBs were identified, with dental prostheses (60.0%) being the most common type, followed by natural teeth (10.0%). FBs were slightly more common on the right side (53.3%) than on the left side (43.3%), with the right lower lobe being the most frequent site of lodgement (30.0%), followed by the left lower lobe (20.7%). The most frequently bronchoscopic findings were mucosal edema (36.7%) and bleeding (26.7%). FB removal was performed using flexible bronchoscopy in 26 patients (92.9), with the exception of two cases (7.1%) in which rigid bronchoscopy was employed. Bronchoscopy was performed in the endoscopy room for 21 patients (75.0%). Among the 28 patients, standard forceps were used in 24 (85.7%), followed by basket forceps, which was employed in 10 patients (35.7%). FB removal was successful in 26 (92.9%) patients. Regarding adverse events, hypoxia was the only complication observed, occurring in 18 patients (64.3%); no other adverse events were reported.</p> Conclusions <p>Most FB in the lower airways can be successfully and safely removed via flexible bronchoscopy.</p>