Uncapped Metered-Dose Inhalers: A Risk for Foreign Body Aspiration. A Case Report and Review of the Literature

Abstract

Dirk Schürmann, Jacopo Saccomanno, Bettina Temmesfeld-Wollbrück, Martin Witzenrath, Ralf-Harto Hübner Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, 10117, GermanyCorrespondence: Dirk Schürmann, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany, Tel [phone], Email [email protected]: The risk of foreign body aspiration associated with uncapped handheld metered-dose inhalers (MDIs) is underestimated. We report a case in which a plastic cable clip accidentally lodged in the mouthpiece of an uncapped pressurized MDI was aspirated during its use. A literature search revealed 16 other cases of foreign body aspiration associated with uncapped handheld inhalers, all but one of which were pressurized inhalers. Patients should be informed of the risk of foreign body aspiration associated with uncapped pocket inhalers. The use of an uncuffed armoured tracheal tube with a separate oxygen tubing during flexible bronchoscopy for foreign body removal ensures a safe airway. Foreign bodies that exceed the lumen size of the tracheal tube can be pulled to the distal opening with forceps and removed when the tube is withdrawn.Plain Language Summary: Handheld pocket inhalers have significantly improved the treatment of patients with chronic obstructive pulmonary disease. We report a case in which a plastic cable clip accidentally lodged in the mouthpiece of an uncapped pressurized pocket inhaler was aspirated during its use. Depressing the plunger of the inhaler released the inhalant in a high-velocity spray, which was inhaled with a deep breath while simultaneously aspirating the plastic cable clip. The risk of foreign body aspiration associated with uncapped pressurized metered-dose inhalers is underestimated. Patients using pocket inhalers should be informed of the risk of foreign body aspiration with uncapped inhalers. Inhalers should always be kept capped except during use to prevent small objects from accidentally entering the mouthpiece. The cap of the inhaler mouthpiece should only be removed when the inhaler is used. Foreign bodies that have accidentally become lodged in the mouthpiece of an inhaler and aspirated into the lungs can usually be removed by specialists during a short outpatient procedure.Keywords: foreign body aspiration, metered-dose inhaler, removal of aspirated foreign bodies, uncuffed armoured tracheal tube with separate oxygen tubing

Keywords

• foreign body aspiration
• metered-dose inhaler
• removal of aspirated foreign bodies
• uncuffed armoured tracheal tube with separate oxygen tubing