Foreign body aspiration following unconventional use of a metered dose inhaler

Abstract

Purpose: Aspiration of a foreign body may be life-threatening. This report describes laryngeal obstruction after inhalation of a piece of a Turbuhaler® which resulted from a patient tampering with the device.Clinical features: A 27-yr-old man disassembled a Turbuhaler® and inadvertently aspirated a plastic dispensing medication disc (22 mm diameter) while attempting to inhale the remnant terbutaline sulfate which accumulated on it. Although the patient was hoarse, he was not in acute respiratory distress. X-ray revealed the disc lodged in the larynx below the vocal cords. The patient was immediately transferred to an operating theatre, and a drying agent (glycopyrrolate), judicious sedation (midazolam and fentanyl) and O 2 were administered. The airway was anesthetized with lidocaine 4% delivered using high-flow O 2 through an atomizer. Direct laryngoscopy revealed a partially obstructed view of the disc lodged distal to the vocal cords which was inaccessible for retrieval. Loss of consciousness was subsequently induced by spontaneous mask ventilation with sevoflurane (in O 2 ). The airway was visualized using a suspension laryngoscope and the foreign body was removed with grasping forceps. The patient was awakened, transferred to the ICU and given 4 mg decadron iv every eight hours (two doses). Laryngoscopy prior to discharge indicated good mobility of the vocal cords and normal glottic structure.Conclusion: Aspiration of a foreign body is a potentially life-threatening situation requiring coordination between anesthesiologist, surgeon, and nursing staff. Anesthetic goals include avoidance of upper airway obstruction and maintenance of adequate ventilation while the foreign body is retrieved. Provisions must be made for tracheostomy if these goals cannot be realized.Objectif : L'aspiration d'un corps étranger peut être dangereuse. Dans le présent article, on décrit une obstruction laryngée survenue après l'inhalation d'une pièce de Turbuhaler®, le patient ayant modifié l'appareil.Éléments cliniques : Un homme de 27 ans a démonté un Turbuhaler® et aspiré par inadvertance un disque distributeur de médicament de 22 mm de diamètre en tentant d'inhaler du sulfate de terbutaline qui s'y était accumulé. Même si le patient était enroué, il ne présentait pas de détresse respiratoire aiguë. La radiographie a révélé la présence du disque dans le larynx, sous les cordes vocales. Le patient a été amené immédiatement en salle d'opération où il a reçu un médicament asséchant (glycopyrrolate), une sédation appropriée (midazolam et fentanyl) et de l'O 2 . Les voies aériennes ont été anesthésiées avec de la lidocaïne à 4 % administrée à l'aide d'un atomiseur d'O 2 à haut débit. La laryngoscopie directe a révélé une vision partiellement obstruée du disque logé sous les cordes vocales et inaccessible. La perte de conscience a été induite par la suite par la ventilation spontanée au masque avec du sévoflurane dans de l'O 2 . On a pu visualiser les voies aériennes en utilisant un laryngoscope à suspension et le corps étranger a été ...

An unusual mechanism of foreign body aspiration: a vignette from the emergency department

“…The only other case report that I could find which pertains to foreign body inhalation secondary to inhaler use, was published by Campisi et al 1. The case describes a 27-year-old man inhaling a 22 mm plastic disc from his turbohaler after tampering with it.…”

Inhaler screw‐up: A real world cystic fibrosis (CF) case

“…Since it is a rare lung pathology and entity in adults, aspiration of FB is commonly missed and can lead to complications such as pneumonia, atelectasis, pneumothorax, abscess, foreign body dislodgement, and bronchiectasis. Early diagnosis and appropriate intervention are vital to reduce unnecessary complications and mortality …”

“…Choking sensation, cough, wheeze, dyspnoea, and decreased air entry are the common clinical features. Detailed history, supportive CXR and CT findings are the crucial to reach a definitive diagnosis . Bronchoscopic intervention offers both diagnosis and management and provide enough visualization for better outcome …”