An Unusual Death in an Asthmatic Patient

Abstract

A 35-year-old black woman with a history of bronchial asthma collapsed and died after ingestion of three 20-mg tablets of propranolol. She was recently treated in the emergency department at a local hospital for an acute asthma exacerbation and was given a written prescription for prednisone. The prescription was filled and the medication was taken as prescribed. Within minutes after ingestion of the medication, she became acutely short of breath and was witnessed to collapse. Paramedics responded to the scene and initiated resuscitative efforts while en route to the local emergency department. The decedent was unable to be resuscitated and was pronounced dead shortly after reaching the hospital. It was later discovered that the medication she was given by the pharmacy was 20-mg propranolol tablets instead of 20-mg prednisone tablets.

Absence of respiratory effects with ivabradine in patients with asthma

“…A number of case reports have demonstrated the ability of β‐blockers to cause bronchospasm, even in mild asthma [5]. Bronchospasm can be severe, prolonged, and difficult to treat [14], and β‐blocker‐related bronchospasm is thought to have caused death in a number of patients with asthma [15, 16]. An alternative treatment that does not act through β‐adrenergic receptors would therefore be welcome for angina in patients with respiratory disease.…”

Changes in β2-adrenoceptor and other signaling proteins produced by chronic administration of ‘β-blockers’ in a murine asthma model

“…On the other hand, β-AR antagonists/inverse agonists ('β-blockers') are contraindicated in asthma, because of reports that single doses or short-term administration of these drugs may cause severe worsening of asthma and even fatalities [14][15][16]. Again similar to asthma, 'βblockers' were contraindicated in CHF because initially they make patients feel worse and decreases cardiac contractility [17].…”

Advances in the Diagnosis and Management of Asthma in Older Adults

“…Initiating β-blocker therapy in the older asthmatic must be performed under close supervision as severe life-threatening symptoms may be triggered by the initial dose (24,25) . There is however evidence suggesting that escalating β-blocker therapy in asthmatics is well tolerated (26) .…”