Skip to main content

Bronchoscopy as a salvage therapy in a mechanically ventilated status asthmaticus patient: A case report

Abstract

A 23-year-old male patient presented with acute exacerbation of asthma with type 2 respiratory failure. He was mechanically ventilated and started on intensive medical therapy including nebulization with β2 agonists and antimuscarinic drugs, steroids, antibiotics and magnesium sulphate as per standard protocol. As there was no response to the abovementioned line of treatment, other nonstandard therapies such as intramuscular adrenaline and ketamine were also tried but to no avail. After a meticulous literature search, bronchoscopy was planned to look for any alternative diagnoses as well as to perform bronchial toileting. The patient showed dramatic improvement after the procedure, was subsequently extubated and discharged in stable condition. This case essays the significant role of bronchoscopy in refractory status asthmaticus patients, discusses the pathophysiological mechanisms addressed by bronchoscopic toileting and, furthermore, reviews the contemporary literature for evidence in its favour.

References

  1. McFadden ER Jr. Acute severe asthma. Am J Respir Crit Care Med 2003; 168:740–759.

    Article  Google Scholar 

  2. Shapiro JM. Intensive care management of status asthmaticus. Chest 2001; 120:1439–1441.

    CAS  Article  Google Scholar 

  3. Expert Panel Report 3 (EPR-3). Guidelines for the diagnosis and management of asthma-summary report 2007. National Asthma Education and Prevention Program. J Allergy Clin Immunol 2007; 120:S94–S138.

  4. Zamanian M, Marini JJ. Pressure-flow signatures of central-airway mucus plugging. Crit Care Med 2006; 34:223–226.

    Article  Google Scholar 

  5. Kuyper LM, Paré PD, Hogg JC, Lambert RK, Ionescu D, Woods R, Bai TR. Characterization of airway plugging in fatal asthma. Am J Med 2003; 115:6–11.

    Article  Google Scholar 

  6. Thompson HT, Pryor WJ, Hill J. Bronchial lavage in the treatment of obstructive lung disease. Thorax 1966; 21:557–559.

    CAS  Article  Google Scholar 

  7. Walker PE, Marshall M. Bronchial lavage in status asthmaticus. Br Med J 1969; 3:31–32.

    CAS  Article  Google Scholar 

  8. British Guideline on the Management of Asthma. British thoracic society Scottish intercollegiate guidelines network. Thorax 2008; 63:iv1–iv121.

    Article  Google Scholar 

  9. Brenner B, Corbridge T, Kazzi A. Intubation and mechanical ventilation of the asthmatic patient in respiratory failure. Proc Am Thorac Soc 2009; 6:371–379.

    Article  Google Scholar 

  10. Khan MF, Al Otair HA, Elgishy AF, Alzeer AH. Bronchoscopy as a rescue therapy in patients with status asthmaticus: two case reports and review of literature. Saudi J Anaesth 2013; 7:327–330.

    Article  Google Scholar 

  11. Maggi JC, Nussbaum E, Babbitt C, Maggi FE, Randhawa I. Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure. Pediatr Pulmonol 2012; 47(12):1180–1184.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Animesh Ray MBBS, MD(Med), DNB(Med), MNAMS, MRCP(UK), EDICI.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ray, A., Nangia, V., Chatterji, R. et al. Bronchoscopy as a salvage therapy in a mechanically ventilated status asthmaticus patient: A case report. Egypt J Bronchol 11, 66–69 (2017). https://doi.org/10.4103/1687-8426.198985

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.198985

Keywords

  • asthma
  • bronchoscopy
  • mechanical ventilation
  • salvage