How should an airbag-induced cough be managed?

Management of Airbag-Induced Cough

Treat airbag-induced cough as an acute irritant-induced airway injury with inhaled corticosteroids and bronchodilators, while monitoring for progression to persistent asthma or chemical pneumonitis. 1, 2

Immediate Assessment and Recognition

The key to managing airbag-induced cough is understanding the mechanism of injury. When airbags deploy, they release a corrosive alkaline aerosol containing sodium hydroxide, high-temperature gases, carbon dioxide, and metallic oxides that can cause both supraglottic and subglottic airway inflammation. 1, 3

Critical red flags requiring urgent evaluation include: 4, 5

• Respiratory distress or difficulty breathing
• Persistent wheezing or bronchospasm
• Productive cough with significant sputum
• Chest pain or hemoptysis
• Fever with rapid breathing

Initial Treatment Approach

For acute presentation (within hours to days of airbag exposure): 1, 2

• Initiate inhaled corticosteroids immediately to address airway inflammation
• Add inhaled bronchodilators (beta-2 agonists) for bronchospasm and wheezing
• Consider oral antibiotics if secondary bacterial sinusitis or pneumonitis is suspected based on clinical findings
• Provide supportive care with hydration and rest 4

The evidence from case reports demonstrates that patients exposed to airbag contents develop acute airway inflammation affecting both upper and lower airways, often with concurrent sinusitis. 1 One documented case showed extensive sinusitis on CT imaging requiring this combination therapy. 1

Monitoring for Persistent Disease

The critical pitfall is failing to recognize that airbag exposure can cause new-onset, persistent irritant-induced asthma. 2 A well-documented case showed a previously healthy patient developing permanent asthma requiring daily controller medications after airbag exposure, with markedly positive methacholine challenge testing persisting 2.5 years post-exposure. 2

Follow-up assessment should include: 2, 6

• Re-evaluation at 2-4 weeks to assess symptom resolution
• Spirometry with bronchodilator response if symptoms persist beyond initial treatment
• Methacholine challenge testing if asthma is suspected but spirometry is normal
• Chest imaging if pneumonitis is suspected (bilateral interstitial changes may be present) 1, 6

Treatment Algorithm Based on Clinical Course

If cough resolves within 1-2 weeks: 4

• Discontinue medications after symptom resolution
• Provide return precautions for worsening symptoms

If cough persists beyond 3 weeks or worsens: 7, 8

• Obtain chest radiograph to evaluate for pneumonitis or other complications 1, 6
• Perform spirometry with bronchodilator response 7
• Consider CT imaging of sinuses if upper airway symptoms predominate 1
• Intensify inhaled corticosteroid therapy and continue bronchodilators 2

If reactive airway symptoms develop (bronchospasm with nonspecific triggers): 2

• Treat as new-onset asthma with daily controller therapy (inhaled corticosteroids plus long-acting bronchodilators)
• Provide rescue inhaler for acute symptoms
• Consider allergy testing and methacholine challenge to confirm diagnosis 2

Common Pitfalls to Avoid

Do not dismiss persistent symptoms as anxiety or minor irritation. The literature clearly documents that airbag exposure can cause permanent respiratory disease requiring long-term treatment. 2 Prompt institution of aggressive anti-inflammatory therapy may prevent or dampen persistent disease. 2

Do not use antibiotics empirically for viral-appearing symptoms without evidence of bacterial infection. 4 However, the alkaline aerosol from airbags can cause chemical injury predisposing to secondary bacterial sinusitis or pneumonitis, which does warrant antibiotic treatment. 1

Do not rely on normal initial chest radiograph to exclude significant disease. Patients may develop chemical pneumonitis or persistent asthma despite initially normal imaging. 1, 6