Treatment of a Patient with Chronic Bronchial Asthma with Many Bronchoscopies and Lavages Using Acetylcysteine: A Case Report

Millman, M; Goodman, Allan H.; Goldstein, I; Millman, F M; Campen, S. S. Van

doi:10.3109/02770908509079881

Cited by 10 publications

(5 citation statements)

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“…N‐acetyl cystein is used in current medical practice in conjunction with chest physiotherapy as a mucolytic agent in patients who have viscid or thickened airway mucus. When administered via direct instillation, it is used to loosen impacted mucus plugs during bronchoscopy [12,13]. Acetyl cysteine opens the disulfide bonds and lowers mucus viscosity [12].…”

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confidence: 99%

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Does N‐acetyl Cystein Affect the Sensitivity and Specificity of Helicobacter pylori Stool Antigen Test?

Demırtürk

Yazgan

Tarçın³

et al. 2003

Helicobacter

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confidence: 99%

“…When administered via direct instillation, it is used to loosen impacted mucus plugs during bronchoscopy [12,13]. Acetyl cysteine opens the disulfide bonds and lowers mucus viscosity [12]. H. pylori is found primarily in mucus and adjacent epithelial cells at the mucosal surface and in gastric pits [13].…”

mentioning

confidence: 99%

Does N‐acetyl Cystein Affect the Sensitivity and Specificity of Helicobacter pylori Stool Antigen Test?

Demırtürk

Yazgan

Tarçın³

et al. 2003

Helicobacter

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“…Auch wenn kontrollierte Studien mit ausreichender Fallzahl dazu fehlen, berichten Einzelbeobachtungen bzw. kleine Fallserien hier von einem therapeutischen Erfolg durch diese invasive Maßnahme bei intubierten und invasiv beatmeten Patienten 156 . Beim spontan atmenden Patienten mit akutem, schweren Asthma ist von einer Bronchoskopie abzusehen, da die Intervention selber oder die erforderliche Sedierung ein Atemversagen induzieren können.…”

Section: Diagnostikunclassified

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

et al. 2023

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ZusammenfassungDas Management von Asthma hat sich in den letzten Jahrzehnten fundamental gewandelt. Die vorliegende Leitlinie zur Diagnostik und Therapie von Asthma wurde für pneumologisch tätige Fachärztinnen und Fachärzte entwickelt, welche detaillierte und evidenzbasierte Informationen zu den neuen diagnostischen und therapeutischen Optionen von Asthma benötigen. Die Leitlinie zeigt die neue Bedeutung der Biomarker, insbesondere der Bluteosinophilen und des exhalierten NO (FeNO), in den diagnostischen Algorithmen von Asthma. Als erste Asthma-Leitlinie weltweit benennt die vorliegende Leitlinie die nachhaltige Symptomprävention und die Asthma-Remission als Asthma-Therapieziele, welche durch den Einsatz individuell angepasster, krankheitsmodifizierender Medikamente (wie inhalative Steroide, Allergenimmuntherapie oder Biologika) erreicht werden können. Die zentrale Bedeutung der Behandlung von typischen Asthma-Komorbiditäten wird zudem betont. Schließlich wird auch auf besondere Herausforderungen im Asthma-Management eingegangen, wie bspw. die Therapie von Asthma in der Schwangerschaft, die Behandlung von schwerem Asthma oder die Diagnostik und Therapie von arbeitsbedingten Asthma-Formen.

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“…Hence, mortality of acute severe respiratory failure related asthma episodes are associated with lung consolidation, atelectasis, or severe mechanical airway obstruction leading to severe hypoxia/hypoxemia. Several studies have shown the potential benefits of bronchoscopy and bronchial lavage with and without mucolytics in adult patients with asthma 17–19, 21, 22. A singular published report on flexible bronchoscopy in children with respiratory failure due to status asthmaticus focused its emphasis on severe atelectasis 15…”

Section: Discussionmentioning

confidence: 99%

Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure

Maggi¹,

Nussbaum²,

Babbitt³

et al. 2012

Pediatric Pulmonology

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Background Status asthmaticus respiratory failure is associated with thickened mucus secretions necessitating aggressive pulmonary clearance. The role of bronchoscopy in pediatric mechanically ventilated asthmatic patients has not been published. Methods A chart review was performed on all pediatric intensive care unit (PICU) asthmatics with respiratory failure over 13 years. Forty‐four patients were identified. Patients were managed per standardized guidelines for status asthmaticus with mechanical ventilation. Ventilator management prioritized spontaneous breathing with pressure support. Extubation criteria included spontaneous tidal volumes of 5–7 cm3/kg on low‐pressure support. Standard endotracheal tube pulmonary toilet were implemented. Twenty‐nine patients underwent bronchoscopy as an adjunctive therapy. Indications for bronchoscopy included: Pathogen identification via bronchoalveolar ravage, atelectasis, mucus obstruction resulting in severe air trapping, suspected aspiration, and poor response to standard therapy. Clinical outcomes of this intervention were compared to the fifteen patient cohort who did not undergo bronchoscopy. Results Bronchoscopies revealed thick mucus plugs, secretions, and bronchial casts. The large airways were lavaged for clearance of obstructive secretions with normal saline. All patients tolerated the procedure without any complications. Demonstrable improvement in pulmonary compliance was noted. The median time of intubation for the bronchoscopy group was 10 hr compared to 20.5 hr for the control group (P < 0.0005). The mean intensive care unit length of stay was 3.06 days for the bronchoscopy group versus 3.4 days for the non‐bronchoscopy group (P < 0.05). Conclusion Flexible bronchoscopy with bronchial lavage is a safe adjunctive therapy in pediatric asthmatics with respiratory failure resulting in reduced mechanical ventilation and intensive care length of stay. Restoring lung volume in certain asthmatics during respiratory failure may be deemed beneficial. Further validated studies are necessary to recommend bronchoscopy to the present, accepted treatment regimen in pediatric asthmatic respiratory failure. Pediatr Pulmonol. 2012; 47:1180–1184. © 2012 Wiley Periodicals, Inc.

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Treatment of a Patient with Chronic Bronchial Asthma with Many Bronchoscopies and Lavages Using Acetylcysteine: A Case Report

Cited by 10 publications

References 0 publications

Does N‐acetyl Cystein Affect the Sensitivity and Specificity of Helicobacter pylori Stool Antigen Test?

Does N‐acetyl Cystein Affect the Sensitivity and Specificity of Helicobacter pylori Stool Antigen Test?

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure

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