Bronchospasm during Anesthesia Induction in A Patient with Undiagnosed Asthma

In large study of 9287 children undergoing general anesthesia, the incidence of perioperative bronchospasm is 2.1 percent. During anesthesia in patients with well-controlled asthma, airway complications such as bronchospasm are rare. However, poorly controlled asthma is closely related to the pathophysiologic mechanisms of nonallergic and allergic bronchospasm. More than 80% of asthma patients have allergic rhinitis, and 10-40% of allergic rhinitis patients have asthma. We report a case of a 10-year-old male with undiagnosed asthma who developed bronchospasm during induction of anesthesia. This patient had been treated for allergic rhinitis before surgery. Unexpected bronchospasm occurred immediately after induction of anesthesia and was treated with salbutamol nebulizer and intravenous dexamethasone. In addition, a massive hypotension-suspected anaphylactic reaction occurred and was treated with intravenous epinephrine, after which airway pressure and vital signs improved. For safety, the operation was canceled, anesthesia was discontinued, and the patient was discharged without specific complications. Asthma was diagnosed upon further evaluation two weeks after discharge. Because this patient had been treated for allergic rhinitis before surgery, asthma should have been diagnosed before surgery. If asthma symptoms before anesthesia were well-controlled using a bronchodilator, steroid, etc., bronchospasm could have been prevented during anesthesia in the current case. This case suggests that, when possible, asthma should be diagnosed before surgery in allergic rhinitis patients. This case also suggests that anesthesia should be performed after good control of asthma symptoms before surgery to prevent life-threatening perioperative events.

Population-based case-finding to identify subjects with undiagnosed asthma or COPD

Background∼5–10% of adults may have undiagnosed airflow obstruction. The objective of this study was to develop a population-based case-finding strategy to assess the prevalence of undiagnosed airflow obstruction (asthma or COPD) amongst adults with respiratory symptoms in Canada.MethodsAdults without a previous history of asthma, COPD or lung disease were recruited using random digit-dialling and asked if they had symptoms of dyspnoea, cough, sputum or wheeze within the past 6 months. Those who answered affirmatively completed the Asthma Screening Questionnaire (ASQ), COPD-Diagnostic Questionnaire (COPD-DQ) and COPD Assessment Test (CAT). Those with an ASQ score of ≥6 or a COPD-DQ score of ≥20 underwent pre- and post-bronchodilator spirometry to diagnose asthma or COPD.Results12 117 individuals were contacted at home and assessed for study eligibility. Of the 1260 eligible individuals, 910 (72%) enrolled and underwent spirometry. Ultimately, 184 subjects (20% of those enrolled) had obstructive lung disease (73 asthma and 111 COPD). Individuals found to have undiagnosed asthma or COPD had more severe respiratory symptoms and impaired quality of life compared with those without airflow obstruction. The ASQ, COPD-DQ, and CAT had ROC areas for predicting undiagnosed asthma or COPD of 0.49, 0.64 and 0.56, respectively. Four descriptive variables (age, BMI, sex and pack-years smoked) produced better receiver operating characteristic (ROC) values than the questionnaires (ROC area=0.68).Conclusion20% of randomly selected individuals who report respiratory symptoms in Canada have undiagnosed airflow obstruction due to asthma or COPD. Questionnaires could exclude subjects at low risk but lack the ability to accurately find subjects with undiagnosed disease.