Foreign body aspiration following unconventional use of a metered dose inhaler

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

A 40-year-old male with Cystic Fibrosis developed a sudden onset choking, cough, dyspnea and hemoptysis after using his inhaler. He presented to A&E. CT scan located a foreign body in his right bronchus intermedius (RBI). Rigid bronchoscopy was performed and removed a plastic rawl plug with screw from his RBI. He made a rapid recovery. On questioning he mentioned he had stored his inhaler uncapped in the same pocket he had this screw which he found at work. Small objects can lodge in inhalers due to their design/mouthpiece uncapping. This can result in endobronchial foreign body aspiration. This case highlights the importance of replacing inhaler cap when not in use.

Treasure in the chest

A 41-year-old woman with a background of asthma was preparing for a party on New Year's Eve when she developed a mild wheeze. Concerned her symptoms would develop and impact on festivities, she located her uncapped salbutamol inhaler in her handbag. Ignoring the coarse rattle as she shook it, she proceeded to take a deep inspiration. Instantly, she felt a painful scratch in her pharynx followed by a harsh cough, which persisted over the next few minutes and became associated with haemoptysis. She was taken to the accident and emergency department. Chest X-ray revealed a radiodense foreign body in the distal right main bronchus. During endoscopy, an earring, causing subtotal occlusion in the right lower lobe bronchus was found and extracted. Her observations remained within normal limits throughout. The importance of replacing caps on inhalers when not in use is illustrated and should be encouraged when inhaler technique is taught or reviewed.

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

A 49-year-old male patient with asthma presented with what appeared to be an acute exacerbation of his condition. On closer questioning, he was admitted to 'inhaling something' that may have been caught in the mouthpiece of his inhaler and wondered whether there might be something in his chest. On examination, he had a monophonic high-pitched wheeze in his right mid-zone; chest X-ray confirmed the presence of a foreign body in his right main bronchus. As it was after normal working hours, he was referred for bronchoscopy under the cardiothoracic surgeons at St George's. He made a full recovery, and now keeps a used 5 pence coin in a jar on his mantelpiece.

Estimates of medical device--associated adverse events from emergency departments

BACKGROUND

The true public health burden of adverse events associated with medical devices is unknown. The purpose of this study, therefore, was to produce the first-ever national estimates of medical device-associated adverse events resulting in emergency department (ED) visits.

METHODS

From July 1999 through June 2000, reports of 10,395 medical device-associated adverse events were accumulated using the National Electronic Injury Surveillance System (NEISS), which collects information on product-related injuries from the ED records of a national stratified probability sample of hospitals. The reports were used to estimate annual total number of medical device-associated adverse events as well as number of adverse events associated with specific devices, injury diagnoses, demographic characteristics, and patient disposition status.

RESULTS

The total estimated number of adverse events was 454,383 (95% confidence interval [CI]=371,156-537,610), involving a broad range of devices from 15 medical specialty groups. Unintentional traumatic events associated with a particular device appeared to be the most common mechanism of injury. The most prevalent types of injuries included contusions/abrasions, punctures, and lacerations; 13% of total estimated cases resulted in patient hospitalization. Adverse events occurred within healthcare facilities, and some were occupationally related, although they occurred at home more frequently than any other location (about 42%).

CONCLUSIONS

The magnitude of the total estimate, which is over four times greater than the annual number of adverse event reports received by medical device-regulating surveillance systems, emphasizes medical device-associated adverse events as an under-recognized public health problem. Planned collection of more detailed NEISS data will allow for appropriate public health interventions.