P001 A Case of ipratropium bromide allergy in a patient with severe persistent asthma

Jayaraman, Dilip Kumar; Brar, K. S.

doi:10.1016/j.anai.2016.09.009

Cited by 3 publications

(2 citation statements)

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“…One case highlighted such an effect in adults [2] and many cases have been described a similar adverse response to beta-agonists [3,4]. Interestingly, an allergic response to Ipratropium has been highlighted in a paediatric patient whose mother had similarly developed a reaction to Ipratropium in the past [5].…”

Section: Discussionmentioning

confidence: 96%

Ipratropium induced bronchoconstriction in a young Asthmatic: A case report

Aleshaa¹,

Collindridge²,

Singh³

2021

Arch Case Rep

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Acute severe Asthma is a common paediatric emergency managed according to the BTS and SIGN guidelines. They recommend that if initial β2 agonist treatment bears no response, frequent Ipratropium Bromide doses can be given every 20-30 minutes [1]. We present a case of paradoxical bronchospasm to Ipratropium, an observed but rare side effect. Case ReportAn eight-year-old girl presented to the Emergency Department with cough and shortness of breath. Her asthma was usually well controlled with Beclamethasone 100 micrograms twice-daily, Montelukast once-daily, and Salbutamol as and when required. She had no history of rhinoconjunctivitis nor any allergic triggers. She was diagnosed with an acute non-infectious exacerbation of Asthma and given ten puffs of Salbutamol inhaler every 20 minutes over one hour. As she showed marked symptomatic improvement, she required no investigation and was discharged with a wheeze plan and oral amoxicillin cover for seven days. However, she returned that evening with increasing breathlessness and an audible wheeze on auscultation. She was then started on ten puffs Salbutamol MDI, two puffs Ipratropium Bromide inhaler 20 microgram via spacer and Prednisolone 40 mg. She responded to the treatment and Salbutamol was gradually spaced to four-hourly. The next day she was discharged with a three-and seven-day course of Prednisolone and Amoxicillin to complete, respectively.

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Section: Discussionmentioning

confidence: 96%

Ipratropium induced bronchoconstriction in a young Asthmatic: A case report

Aleshaa¹,

Collindridge²,

Singh³

2021

Arch Case Rep

View full text Add to dashboard Cite

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“…Healthcare professionals working in hospitals can come into close contact with numerous types of occupational hazards such as exposure to reproductive hazards (Lawson et al, 2012) as well as infectious agents and blood borne pathogens (Veccio et al, 2003). Exposure of healthcare workers to medications, especially when performing treatments involving aerosolized drugs, has the potential for significant reactions, including, but not limited to bronchospasm, allergy, and anaphylaxis (Nicklas, 1990;Riordan and Smaldone, 1992;Bone and Amundson, 1993;Jayaraman and Brar, 2016). Home healthcare workers (HHWs) providing their services in patients' homes do not have the benefit of working in a controlled environment such as a hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Inhalation Exposure and Respiratory Protection of Home Healthcare Workers Administering Aerosolized Medications (Simulation Study)

Ollier

Leppänen

et al. 2019

Aerosol Air Qual. Res.

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There is little information regarding aerosol exposure from using medical nebulizers and the factors affecting the risk of exposure, especially for treatments performed in a patient's home environment. Home healthcare workers (HHWs) are a rapidly growing work population often exposed to aerosol hazards. Thus, we designed a simulated environment to measure the aerosol inhalation exposure of an HHW administering pressure-nebulized medications. We determined the relative contributions of different factors to aerosol reduction, namely, the room air exchange rate, proximity to the patient, and patient breathing rate, in an exposure chamber simulating a patient's bedroom. Additionally, the performance of respiratory protective devices worn by an HHW, a surgical mask and N95 filtering facepiece respirator (FFR), was evaluated using NaCl as a well-established surrogate. The particle concentration in the breathing zone of an unprotected worker ranged from 7,118 to 284,600 cm -3 . The proximity to the aerosol source affected the aerosol concentration, but the influence of this factor diminished when the distance increased beyond 24 inches. For an unprotected HHW, ventilation was the most effective way to reduce exposure to nebulizer-produced medical aerosols. An increase in the air exchange rate from 0 to 5 h -1 significantly reduced the exposure; however, a further increase (to 17 h -1 ) produced only a small reduction in the particle concentration. Therefore, no evidence suggests that patient homes require extremely efficient ventilation to mitigate HHWs' exposure to nebulizer-produced medications. Increasing the patient's breathing flow rate reduced the aerosol inhalation exposure; however, this factor cannot be controlled, which weakens its practical viability. Wearing respiratory protection devices was found to be the most efficient way to reduce aerosol exposure (within the set of tested variables). As expected, an N95 FFR with a proper seal was about 20-fold more efficient than a surgical mask.

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Ipratropium-induced bronchospasm in a Chronic Obstructive Pulmonary Disease patient-arare and serious clinical vignette of altered drug response: a case report

Anil,

Iyer

et al. 2024

Preprint

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Background: Ipratropium, an anticholinergic medication, holds a significant position in the management of various respiratory disorders. Primarily utilized in the pharmacotherapy of chronic obstructive lung disease and to relieve the symptoms of bronchospasm by acting on the muscarinic receptors of the bronchial smooth muscle by inhibiting the same receptors.This case report aims to highlight the ipratropium-induced bronchospasm in a patient of Chronic Obstructive Pulmonary Disease (COPD). Case Presentation: We present a compelling case of severe bronchospasm occurring in a 65-year-old Indian man following the inhalation of a combination of ipratropium bromide and budesonide. This distressing event was accompanied by a precipitous decline in oxygen saturation, plummeting to as low as 40%. Urgent resuscitation measures were imperative, leading to intubation and ventilatory support to restore the patient to a stable state. Following the initial resuscitation, the patient was transferred to the intensive care unit for further management. Disturbingly, another exacerbation of symptoms ensued during ventilator support subsequent to nebulization with a combination of ipratropium and levosalbutamol. Encouragingly, the patient's condition ameliorated upon discontinuation of the nebulization. Conclusion: This case report illuminates the concerning potential for ipratropium-induced bronchospasm in COPD patients. As we navigate these complexities, the pursuit of safer alternatives like tiotropium takes center stage, reminding us of the continuous evolution in optimizing respiratory therapies. These findings emphasize the significance of vigilant monitoring and tailored interventions in clinical practice.

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P001 A Case of ipratropium bromide allergy in a patient with severe persistent asthma

Cited by 3 publications

References 0 publications

Ipratropium induced bronchoconstriction in a young Asthmatic: A case report

Ipratropium induced bronchoconstriction in a young Asthmatic: A case report

Inhalation Exposure and Respiratory Protection of Home Healthcare Workers Administering Aerosolized Medications (Simulation Study)

Ipratropium-induced bronchospasm in a Chronic Obstructive Pulmonary Disease patient-arare and serious clinical vignette of altered drug response: a case report

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