Treatment of Acute Bronchospasm and Chemical Pneumonitis
For acute bronchospasm and chemical pneumonitis, the first-line treatment is short-acting β-agonists such as albuterol via nebulization or metered-dose inhaler to relieve bronchospasm, followed by systemic corticosteroids to reduce inflammation. 1, 2
Initial Management
Bronchodilator Therapy
- Administer short-acting β-agonists (albuterol) via nebulization or metered-dose inhaler as first-line treatment for bronchospasm 1, 2
- For severe bronchospasm, consider adding anticholinergic bronchodilators (ipratropium bromide) if the patient does not show prompt response to β-agonists at maximal dose 1
- Continue bronchodilator therapy until clinical improvement is observed 1
Oxygenation
- Provide supplemental oxygen to maintain adequate oxygenation 1
- Monitor oxygen saturation closely 1
- For patients with severe respiratory distress or hypoxemia, consider non-invasive ventilation, particularly in patients with COPD 1
Anti-inflammatory Therapy
- Administer systemic corticosteroids to reduce airway inflammation and prevent recurrence of symptoms 1
- For chemical pneumonitis specifically, systemic glucocorticoids have shown significant improvement in hypoxemia and dyspnea 3
Secondary Management
Fluid Management
- Ensure adequate hydration to help mobilize secretions 1
- For patients with severe sepsis, provide appropriate fluid resuscitation 1
Antibiotic Therapy
- Antibiotics are generally not indicated for uncomplicated bronchospasm 1
- Consider antibiotics only if there is evidence of bacterial infection (increased sputum purulence, increased sputum volume, increased dyspnea) 1
Thromboprophylaxis
- Low molecular weight heparin is indicated in patients with acute respiratory failure 1
Monitoring and Follow-up
- Assess response to treatment within 48-72 hours 1
- Monitor for clinical improvement including decreased work of breathing, improved oxygen saturation, and reduced wheezing 1
- For patients with chemical pneumonitis, consider chest imaging to monitor progression of infiltrates 3
Special Considerations
Chemical Pneumonitis-Specific Approach
- Remove the patient from exposure to the chemical irritant 3
- Consider systemic glucocorticoids as they have shown benefit in cases of chemical pneumonitis 3
- Monitor for development of secondary bacterial infection 1, 3
Cautions and Pitfalls
- Be aware that paradoxical bronchospasm can rarely occur with albuterol administration, presenting as worsening shortness of breath after treatment 4
- Theophylline should not be used for treatment of acute exacerbations due to risk of side effects and lack of benefit 1
- In patients with asthma presenting with acute hypercapnic respiratory failure, non-invasive ventilation should not be used; consider early intubation if respiratory failure progresses 1
Severe Cases
- For patients with persistent or deteriorating acidosis despite optimal non-invasive ventilation, consider invasive mechanical ventilation 1
- In cases of severe chemical pneumonitis with rapid deterioration, early intubation and mechanical ventilation may be necessary 1, 3
Medication Dosing
- Albuterol: Nebulizer solution 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 4-8 puffs every 20 minutes for 3 doses then every 1-4 hours as needed via metered-dose inhaler with spacer 2, 5
- Ipratropium bromide: 0.5 mg via nebulizer every 6 hours or 4-8 puffs via metered-dose inhaler every 6 hours 1
- Systemic corticosteroids: Prednisone 40-60 mg daily for 5-7 days 1