Acute Mania as an Essential Contributor for Failed Extubation in an Asthmatic Patient: A Case Report

Failed extubation is not uncommon in intensive care unit and are known to have high morbidity outcomes. The predictors are well-established and known to intensivist, but the complexity is to identify the contributors of these predictive factors. The failure to treat the contributing factors hampered the effort towards successful extubation. To the best of our knowledge, this is the first reported case of acute mania as the essential contributor for failed extubation. This case report illustrates on how an acute mania state prompting an exacerbation of asthmatic attack due to the physical and emotional hyperarousal that ultimately led to the failed extubation.

Pregnancy Outcomes among Women with Intermittent Asthma: A Retrospective Cohort Study

Background: It is already known that asthma strongly increases risks of poor pregnancy outcomes. We wonder whether intermittent asthma, the least severe form but accounting for the majority of cases, increases such adverse outcomes or not. Therefore, we conducted this study to compare adverse pregnancy outcomes between pregnancies with intermittent asthma and low-risk pregnancies (controls). Methods: The full medical records of pregnancies with intermittent asthma were comprehensively reviewed and low-risk pregnancies were randomly recruited as controls with a ratio of 10:1. The obstetric outcomes were compared between both groups, and the outcomes in the active subgroup of intermittent asthma (defined as at least one asthmatic attack during pregnancy) were also compared with the controls. Results: Of 364 study cases and 3640 controls, the rates of poor outcomes (preterm birth, preeclampsia, fetal growth restriction etc.) were not significantly different. However, cases with active disease slightly, but significantly, increased the risk of low birth weight. Moreover, mean gestational age was significantly lower in the study group. Conclusions: A new insight gained from this study is that intermittent asthma is not associated with poor pregnancy outcomes, but cases with asthmatic attack during pregnancy tended to increase the risk of preterm birth and low birth weight. This information is important for counseling and the planning of antepartum management.

Salbutamol-induced lactic acidosis in status asthmaticus survivor

Background Salbutamol-induced lactic acidosis is a rare presentation that could manifest in specific clinical context as acute asthmatic attack treatment. An increase of glycolysis pathway leading to pyruvate escalation is the mechanism of hyperlactatemia in β2-adrenergic agonist drug. Case presentation A 40-year-old man who had poor-controlled asthma, presented with progressive dyspnea with coryza symptom for 6 days. He was intubated and admitted into medical intensive care unit due to deteriorated respiratory symptom. Severe asthmatic attack was diagnosed and approximate 1.5 canisters of salbutamol inhaler was administrated within 24 h of admission. Initial severe acidosis consisted of acute respiratory acidosis from ventilation-perfusion mismatch and acute metabolic acidosis resulting from bronchospasm and hypoxia-related lactic acidosis, respectively. The lactate level was normalized in 6 h after hypoxemia and ventilation correction. Given the lactate level re-elevated into a peak of 4.6 mmol/L without signs of tissue hypoxia nor other possible etiologies, the salbutamol toxicity was suspected and the inhaler was discontinued that contributed to rapid lactate clearance. The patient was safely discharged on the 6th day of admission. Conclusion The re-elevation of serum lactate in status asthmaticus patient who had been administrated with the vast amount of β2-adrenergic agonist should be considered for salbutamol-induced lactic acidosis and promptly discontinued especially when there were no common potentials.

Paediatric Asthma associated with passive smoking and garbage burning: A case report from Kedah, Malaysia

Background Combatting with childhood asthma is a global challenge. Exposure to allergens, air pollutants, tobacco smoke, cold air, viral infection, and family history, are the few major causative factors for asthma. An eleven years old boy from Kedah, Malaysia, had the first asthmatic attack at the age of eight. Possible causes behind the development of his asthmatic attack include passive smoking, environment pollutant created by open residential burning of rubbish practiced by his family members, repeated exposure to allergens such as pollen, house dust mite, animal dander, and eczema. The patient has been treated with inhaled salbutamol BP (100μg/day), oral montelukast Na (5 mg/day) and mometasone furoate (55mcg. once daily). In conclusion, episodes of asthmatic attacks were mainly correlated with passive smoking & burning garbages. Comprehensive approaches such as health education, avoidance of the allergen, cleaning, and maintaining these practices can prevent the development of this morbid illness.

Ability of School Teachers to Manage Asthmatic Attacks Among School Going Children in Jordan

BACKGROUND: Chronic asthma has been characterized by recurrent episodes of wheezing and breathing. However, the frequency and severity of the disease vary from one person to another. PURPOSE: The study aims to assess the ability of school teachers for providing appropriate mediation for the students, who suffer asthmatic attack at school.DESIGN: The study has incorporated descriptive cross sectional quantitative research design to investigate the capability of school teachers in managing asthmatic attack among children. METHODS: Teachers from primary schools have been recruited by using cluster random sample, and a structured questionnaire has been used for data collection. The data acquired from the questionnaire was analyzed using SPSS version 20.0.RESULTS: The results showed that the teachers lack awareness about asthma and unable to manage students with asthma. None of the teachers had received educational conference or workshop about asthma.CONCLUSION: The study has concluded that the level of knowledge of school teachers regarding asthma is limited and not satisfactory; and teachers are also unable to take care for students with asthma.