Abstract: We report a case of paradoxical bronchospasm to both levalbuterol and albuterol. While the exact mechanism for this known adverse effect of albuterol is not known, awareness of this adverse effect can be life saving to the patient. To our knowledge, this is the first reported case of paradoxical bronchospasm to levalbuterol inhalation solution.
Key Words: paradoxical bronchospasm, albuterol, levalbuterol
Albuterol is one of the most common medications used to treat bronchospasm. While it is an effective bronchodilator, paradoxical bronchospasm, which may be life threatening, is a known adverse effect of albuterol. (1) We report a case of paradoxical bronchospasm to both albuterol and levalbuterol.
An 80-year-old gentleman with a history of hypertension, COPD and coronary artery disease was admitted for worsening COPD. The patient had a history of COPD-associated respiratory failure, which required a temporary tracheostomy several years before this admission. Medications upon admission included 2 L of oxygen by nasal cannula, Combivent (ipratropium + albuterol) inhaler, felodipine and aspirin. He had history of ACE inhibitor-induced angioedema. He had a 70-pack-year smoking history, but had quit smoking 1 year before admission. Physical examination revealed an elderly male in moderate respiratory distress with bilateral wheezing. The patient was started on oral prednisone and gatifloxacin, and was given nebulized treatments with albuterol and ipratropium. He remained tachypneic, however, and was transferred to the Intensive Care Unit (ICU).
In the ICU, the patient reported increased shortness of breath with albuterol treatments and was switched to levalbuterol. Within minutes of receiving the levalbuterol, he experienced a significant increase in dyspnea, and a...
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