Hemoptysis Due to MDI Therapy in a Patient With Permanent Tracheostomy: Treatment With Mask Aero Chamber

doi:10.1378/chest.115.1.279

Chest

Volume 115, Issue 1, January 1999, Pages 279-282

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Persistent minor hemoptysis resulted from extensive granulation tissue on the main carina and adjacent bronchi due to frequent spraying of metered-dose inhaler (MDI)-generated aerosol medications directly into a permanent tracheostomy. Salbutamol, containing oleic acid, was considered the most likely cause. After an AeroChamber equipped with an infant mask was interposed between the MDI and the tracheal stoma, hemoptysis and the pathologic changes gradually resolved.

Section snippets

Case Report

Hemoptysis in a 65-year-old laryngectomized man was found to be due to extensive granulation tissue on the tracheal carina and adjacent mucosa. This was thought to have resulted from frequent administration, directly into the stoma, of large doses of bronchodilator and steroid aerosols from oleic acid excipient-containing metered-dose inhalers (MDIs) of albuterol (Ventolin; Glaxo Wellcome; Research Triangle Park, NC) and beclomethasone (Becloforte; Glaxo Wellcome). The use of an AeroChamber

Discussion

This case illustrates an as yet unreported cause of hemoptysis, probably due to chronic tracheal mucosal injury by MDI-generated, inhaled aerosols that were sprayed directly onto the tracheal mucosa through the stoma.

Spraying the MDI directly into the stoma, thus bypassing the aerodynamic filtration of large particles normally accomplished by the upper respiratory tract (URT), results in an approximately 10-fold increase in the deposition of aerosol medication and excipients onto the mucosa of

References (6)

M Dolovich et al.
Clinical evaluation of a simple demand inhalation MDI aerosol delivery device
Chest
(1983)
T Heistracher et al.
The significance of secondary flow for localized particle deposition in bronchial airway bifurcations
J Aerosol Sci
(1995)
GA Salzman et al.
Oropharyngeal candidiasis in patients treated with beclomethasone dipropionate delivered by metered-dose inhaler alone and with Aerochamber
J Allergy Clin Immunol
(1988)

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Selected ReportsHemoptysis Due to MDI Therapy in a Patient With Permanent Tracheostomy: Treatment With Mask Aero Chamber

Section snippets

Case Report

Discussion

Chest

J Aerosol Sci

J Allergy Clin Immunol

Selected Reports
Hemoptysis Due to MDI Therapy in a Patient With Permanent Tracheostomy: Treatment With Mask Aero Chamber