Do beta-adrenergic blocking agents increase asthma exacerbation? A network meta-analysis of randomized controlled trials.

Beta-adrenergic blocking agents (abbreviated as beta-blockers) have been used for treating various cardiovascular diseases. However, the potential for asthma exacerbation is one of the major adverse effects of beta-blockers. This study aimed to compare the level of risk for an asthma attack in patients receiving various beta-blockers. We searched for randomized controlled trials (RCTs) of either placebo-controlled or active-controlled design. The current network meta-analysis (NMA) was conducted under a frequentist model. The primary outcome was the incidence of asthmatic attack. A total of 24 RCTs were included. Overall NMA revealed that only oral timolol [risk ratio (RR) = 3.35 (95% confidence interval (CI) 1.04-10.85)] and infusion of propranolol [RR = 10.19 (95% CI 1.29-80.41)] were associated with significantly higher incidences of asthma attack than the placebo, whereas oral celiprolol [RR = 0.39 (95% CI 0.04-4.11)], oral celiprolol and propranolol [RR = 0.46 (95% CI 0.02-11.65)], oral bisoprolol [RR = 0.46 (95% CI 0.02-11.65)], oral atenolol [RR = 0.51 (95% CI 0.20-1.28)], infusion of practolol [RR = 0.80 (95% CI 0.03-25.14)], and infusion of sotalol [RR = 0.91 (95% CI 0.08-10.65)] were associated with relatively lower incidences of asthma attack than the placebo. In participants with a baseline asthma history, in addition to oral timolol and infusion of propranolol, oral labetalol, oxprenolol, propranolol, and metoprolol exhibited significantly higher incidences of asthma attack than did the placebo. In conclusion, oral timolol and infusion of propranolol were associated with a significantly higher risk of developing an asthma attack in patients, especially in those with a baseline asthma history, and should be avoided in patients who present a risk of asthma.Trial registration: PROSPERO CRD42020190540.

Asthma exacerbations among asthmatic children receiving live attenuated versus inactivated influenza vaccines.

OBJECTIVE: To investigate whether there is a difference in the risk of asthma exacerbations between children with pre-existing asthma who receive live attenuated influenza vaccine (LAIV) compared with inactivated influenza vaccine (IIV). MATERIAL AND METHODS: We identified IIV and LAIV immunizations occurring between July 1, 2007 and March 31, 2014 among Kaiser Permanente Northern California members aged 2 to <18years with a history of asthma, and subsequent asthma exacerbations seen in the inpatient or Emergency Department (ED) setting. We calculated the ratio of the odds (OR) of an exacerbation being in the risk interval (1-14days) versus the comparison interval (29-42days) following immunization, separately for LAIV and IIV, and then examined whether the OR differed between children receiving LAIV and those receiving IIV ("difference-in-differences"). RESULTS: Among 387,633 immunizations, 85% were IIV and 15% were LAIV. Children getting LAIV vs. IIV were less likely to have "current or recent, persistent" asthma (25% vs. 47%), and more likely to have "remote history" of asthma (47% vs. 25%). Among IIV-vaccinated asthmatic children, the OR of an inpatient/ED asthma exacerbation was 0.97 (95% CI: 0.82-1.15). Among LAIV-vaccinated asthmatic children the OR was 0.38 (95% CI: 0.17-0.90). In the difference-in-differences analysis, the odds of asthma exacerbation following LAIV were less than IIV (Ratio of ORs: 0.40, CI: 0.17-0.95, p value: 0.04). CONCLUSION: Among children ≥2years old with asthma, we found no increased risk of asthma exacerbation following LAIV or IIV, and a decreased risk following LAIV compared to IIV.

ECMO for intractable status asthmaticus following atracurium.

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.

Flurbiprofen axetil, nasal polyps, and status asthmaticus: an unusual case report.

INTRODUCTION: Herein, we report a case of life-threatening status asthmaticus in a young male presented with nasal polyps but without any history of anaphylaxis or asthma. DISCUSSION: The patient had normal results from preoperative respiratory systemic examinations. The postoperative asthma, which started after an infusion of nonsteroidal anti-inflammatory drugs (NSAIDs), was severe and difficult to manage. A relationship between the NSAID infusion and the asthma attack was indicated. Flurbiprofen axetil, a nonselective COX2 inhibitor, is most likely the causative agent in this case, although there are no prior reports of asthma caused by this agent. CONCLUSION: We concluded that flurbiprofen axetil evoked severe bronchospasm in this case. Patients who are sensitive to flurbiprofen axetil will usually react to other NSAIDs; therefore, other ordinary NSAIDs should be used with caution in hypersensitive patients. An intranasal ketorolac challenge in individuals with nasal polyps, which is a novel and safe alternative to aspirin challenge, may be recommended to rule out aspirin-exacerbated respiratory disease, prior to the systemic administration of NSAIDs.

Air pollution, weather, and associated risk factors related to asthma prevalence and attack rate.

Asthma is an important public health challenge. The objective of this research was to investigate the relationship of air pollution and weather to adolescent asthma prevalence and attack rate. A 6-month mass screening asthma study was conducted from October 1995 to March 1996 in Taiwan. The study population included junior high school students from throughout the country (1,139,452 students). Eighty-nine percent of students completed questionnaires (International Study of Asthma and Allergies in Childhood-ISAAC and New England Core Questionnaires) and passed a logical screening error program. Lung function data was collected to assist in the diagnosis of asthma status. From the students screened during this mass survey, a stratified random sample of 64,660 students was analyzed for asthma prevalence and attack rate. Using a regression model to compare the USEPA National Ambient Air Quality Standards 2000 (NAAQS, 2000) to asthma prevalence, this investigation found that the standards may not provide enough protection for adolescents after controlling for age, rhinitis, eczema, urban birth location, parental education level, exercise, cigarette smoking, environmental tobacco smoking, alcohol beverage consumption and weather factors. The general estimating equations (GEE) model, a repeated measurement regression model, was used to examine the relationship between the monthly asthma attack rate among asthma patients and air pollution (nitrogen oxides; nitrogen dioxide; nitric oxide; Ozone; PM10) while controlling for household smoking. The GEE model demonstrated that air pollution is related to asthma attack rate. Air pollution factors also interacted with weather parameters when related to asthma attack rate.

[Status asthmaticus with rhabdomyolysis of the respiratory muscles]. / Status asthmaticus mit Rhab domyolyse der Atemmuskulatur.

A 40-year-old roofer called the medical emergency team because of sudden dyspnea and chest constriction. He was suffering from bronchial asthma that exacerbated probably due to the inhalation of a solvent while at work. Because of status asthmaticus he was intubated immediately after arrival in the hospital and breathing had to be assisted artificially for ten hours. After extubation he complained of chest pain. In view of an elevated creatinkinase of 4368 U/1 this was interpreted as rhabdomyolysis of the respiratory muscles due to the status asthmaticus. As a cause of chest pain and elevation of creatinkinase after severe respiratory work under hypoxic conditions rhabdomyolysis of the involved musculature has to be considered.

Inhaled heroin-induced status asthmaticus: five cases and a review of the literature.

We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue.

[Clinical characteristics of near-fatal asthma attack induced by NSAIDs].

Despite advance in the treatment of asthma, asthma-related deaths have not declined. One of the reasons in those cases may be that there is a surprising lack of information on death from asthma since most of asthma deaths take place outside the hospital. Learning about near-fatal asthma attack (NFA) patients is useful to understand the mechanisms of asthma deaths because NFA patients and fatal asthma possess common clinical characteristics. It is well-known that there are two types of severe asthma exacerbation, that is, "sudden onset" and "slow onset attaches", in terms of clinical, functional and blood gas parameters. On the other hand, NSAIDs is one of the factors leading to exacerbation of asthma or asthma-related death. We examined the characteristics of NSAIDs-induced asthma and the pattern of respiratory arrest in the NSAIDs-induced NFA group compared to non-NSAIDs group at a Kyoto National Hospital from 1986 to 1997. A Total of 30 patients (34 cases) with NSAIDs-induced asthma among 265 admissions with asthma attack were reviewed involving 15 women and 15 men, mean age 46 +/- 14 years old. Six patients (8 cases) of NSAIDs group and 13 patients of non-NSAIDs group had intubation for their NFA. NSAIDs group showed more severe respiratory insufficiency with higher arterial CO2 level compared to non-NSAIDs group (91.5 +/- 16.3 vs 76.3 +/- 17.0 Torr) and significant lower pH level (7.02 +/- 0.14 vs 7.18 +/- 0.07, p < 0.05). But, NSAIDs group showed significantly more short weaning time than that of non-NSAIDs group (p < 0.01). We suggest that many sporadic cases of rapid onset severe asthma attacks may result from the ingestion of NSAIDs.

Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman.

OBJECTIVE: We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol. SETTING: Prehospital Emergency Medical Service and Pulmonary Intensive Care Unit in a university hospital. PATIENT: A 35-year-old female developed an acute asthma attack while at home, which required advanced life support. INTERVENTION: On hospital admission, arterial blood gases revealed a PaCO2 of 208 mmHg. Hypercapnia persisted with a PaCO2 of more than 190 mmHg for 10 h, with pH always less than 7.00. The patient was finally discharged after 26 days without sequelae. CONCLUSION: This case illustrates the cerebral and cardiovascular tolerance of severe and prolonged hypercapnia associated with major acidosis.

[Theophylline-associated epilepsy with lacuna infarction].

We reported a 9-year-old boy who had complex partial seizure for the first time, 4 years and 7 months after an episode of theophylline--associated convulsive status. An ictal EEG showed abnormal theta wave burst which showed no superficial focus, implying existence of deep focus in the brain. MRI revealed left thalamic infarction and hippocampal sclerosis. We regarded these abnormalities as the sequelae of theophylline-associated convulsive status.

Hot dog vapor-induced status asthmaticus.

BACKGROUND: Asthma induced by the inhalation of food vapors is unusual and indicative of extreme allergy. Identification of the specific cause and subsequent avoidance is essential. METHODS: We report a patient with asthma who had status asthmaticus following inhalation of boiling hot dog vapors. Prick skin tests were performed to various ingredients of the offending hot dog including chicken, pork, potato, and the aeroallergens. RESULTS: Prick skin tests reacted strongly to chicken and mildly to pork and potato. There was no reaction to aeroallergens. Our patient has not had any acute asthma after avoiding eating and exposure to chicken and hot dog vapors. CONCLUSIONS: Exquisite allergy to chicken was responsible for acute asthma.

Near-death asthmatic reaction induced by disodium cromoglycate.

A near-death asthmatic reaction was induced by disodium cromoglycate (DSCG) as evidenced by positive skin and inhalation provocation tests. The patient's history revealed an episode of exacerbation by inhalation of DSCG. In spite of such an experience, he inhaled DSCG for relief of asthmatic attack, resulting in near-death exacerbation. This patient emphasizes the need to re-recognize that DSCG is not a reliever and the DSCG could cause fatal asthma.

Near-fatal status asthmaticus induced by nasal insufflation of cocaine.

Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine ("snorting") triggered a near-fatal asthmatic attack.

[A case of fatal asthma induced by timolol eye-drop].

A 74 year-old man, a known asthmatic since 1972, was treated by timolol eye-drop for acute glaucoma. Several hours later the patient developed a severe attack of asthma, and died subsequently. The autopsy findings were consistent with those of typical status asthmaticus. Our patient is, to our knowledge, the first case of fatal asthma induced by timolol eye-drop in Japan.