Sudden Respiratory Arrest from Asthma

Abstract

Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. To the Editor:I wish to describe the abrupt onset of respiratory arrest occurring within ten minutes in a previously well-controlled asthmatic subject.The patient is a 31-year-old businessman, non-smoker, with asthma since infancy. He is maintained on theophylline, terbutaline, and cromolyn sodium. In the weeks prior to his illness, he had occasional wheezing that responded promptly to metaproterenol inhaler. While driving his car, he noted some tightness in the chest. Within one to two minutes, wheezing was audible; he became progressively more dyspneic, began using accessory respiratory muscles, and expiration became prolonged. There was no stridor. Within a few minutes he became cyanotic with gasping respirations. Unconsciousness and apnea ensued. Following administration of 0.4 ml of 1:1000 epinephrine subcutaneously and mouth-to-mouth ventilation, spontaneous breathing resumed in about two minutes. Subsequent treatment with intravenous aminophylline and aerosolized isoetharine in an emergency room resulted in the total disappearance of symptoms in 90 minutes. Electrocardiogram and roentgenogram of the chest were normal.The occurrence of life-threatening bronchospasm as the only manifestation of an immediate hypersensitivity reaction is rare. Fatal respiratory failure has been reported in asthmatic patients following injection of bromsulphalein1Venger N Fatal reaction to sulfobromophthalein sodium in a patient with bronchial asthma.JAMA. 1961; 175: 506-508Crossref PubMed Scopus (2) Google Scholar and guinea pig hemoglobin.2Hunt EL Death from allergic shock.N Engl J Med. 1943; 228: 502-506Crossref Google Scholar These patients had marked pulmonary distention, as well as pharyngeal edema at autopsy. Asthmatic patients generally develop respiratory failure over hours to days, not minutes. However, Williams and Levin3Williams MH Levin M Sudden death from bronchial asthma.Am Rev Respir Dis. 1966; 94: 608-611PubMed Google Scholar reported death from overwhelming bronchial obstruction in a patient whose peak flow rate was 120 L/min only one-half hour prior to his demise. Airways have the ability to constrict within minutes to a life-threatening degree, at least in some asthmatic patients. To the Editor: I wish to describe the abrupt onset of respiratory arrest occurring within ten minutes in a previously well-controlled asthmatic subject. The patient is a 31-year-old businessman, non-smoker, with asthma since infancy. He is maintained on theophylline, terbutaline, and cromolyn sodium. In the weeks prior to his illness, he had occasional wheezing that responded promptly to metaproterenol inhaler. While driving his car, he noted some tightness in the chest. Within one to two minutes, wheezing was audible; he became progressively more dyspneic, began using accessory respiratory muscles, and expiration became prolonged. There was no stridor. Within a few minutes he became cyanotic with gasping respirations. Unconsciousness and apnea ensued. Following administration of 0.4 ml of 1:1000 epinephrine subcutaneously and mouth-to-mouth ventilation, spontaneous breathing resumed in about two minutes. Subsequent treatment with intravenous aminophylline and aerosolized isoetharine in an emergency room resulted in the total disappearance of symptoms in 90 minutes. Electrocardiogram and roentgenogram of the chest were normal. The occurrence of life-threatening bronchospasm as the only manifestation of an immediate hypersensitivity reaction is rare. Fatal respiratory failure has been reported in asthmatic patients following injection of bromsulphalein1Venger N Fatal reaction to sulfobromophthalein sodium in a patient with bronchial asthma.JAMA. 1961; 175: 506-508Crossref PubMed Scopus (2) Google Scholar and guinea pig hemoglobin.2Hunt EL Death from allergic shock.N Engl J Med. 1943; 228: 502-506Crossref Google Scholar These patients had marked pulmonary distention, as well as pharyngeal edema at autopsy. Asthmatic patients generally develop respiratory failure over hours to days, not minutes. However, Williams and Levin3Williams MH Levin M Sudden death from bronchial asthma.Am Rev Respir Dis. 1966; 94: 608-611PubMed Google Scholar reported death from overwhelming bronchial obstruction in a patient whose peak flow rate was 120 L/min only one-half hour prior to his demise. Airways have the ability to constrict within minutes to a life-threatening degree, at least in some asthmatic patients.