Background: Ipratropium, an anticholinergic medication, holds a significant position in the management of various respiratory disorders. Primarily utilized in the pharmacotherapy of chronic obstructive lung disease and to relieve the symptoms of bronchospasm by acting on the muscarinic receptors of the bronchial smooth muscle by inhibiting the same receptors. This case report aims to highlight the ipratropium-induced bronchospasm in a patient of Chronic Obstructive Pulmonary Disease (COPD). Case Presentation: We present a compelling case of severe bronchospasm occurring in a 65-year-old Indian man following the inhalation of a combination of ipratropium bromide and budesonide. This distressing event was accompanied by a precipitous decline in oxygen saturation, plummeting to as low as 40%. Urgent resuscitation measures were imperative, leading to intubation and ventilatory support to restore the patient to a stable state. Following the initial resuscitation, the patient was transferred to the intensive care unit for further management. Disturbingly, another exacerbation of symptoms ensued during ventilator support subsequent to nebulization with combination of ipratropium and levosalbutamol. Encouragingly, the patient’s condition ameliorated upon discontinuation of the nebulization. Conclusion: This case report illuminates the concerning potential for ipratropium-induced bronchospasm in COPD patients. As we navigate these complexities, the pursuit of safer alternatives like tiotropium takes center stage, reminding us of the continuous evolution in optimizing respiratory therapies. These findings emphasize the significance of vigilant monitoring and tailored interventions in clinical practice.

Background: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Transesophageal Bronchoscopic Ultrasound-guided fine-needle aspiration (EUS-B-FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta-analysis on the yield and safety of EBUS-TBNA and EUS-B-FNA in children. Methods: We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS-TBNA/EUS-B-FNA in children (<18 years of age). Pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals) were calculated using the random-effects model. Details of any procedure-related complications were noted. Results: The search yielded 12 relevant studies (five case series and seven case reports on EBUS-TBNA/EUS-B-FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS-B-FNA were 98% (95% CI, 92-100%) and 61% (95% CI, 43-77%) respectively. A procedure-related major complication was reported in 1 patient (1/173, Major complication rate 0.6%), and minor complications occurred in 6 patients (6/173, Minor complication rate 3.5%). Conclusions: EBUS-TBNA and EUS-B-FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS-TBNA/EUS-B-FNA may be considered as the first-line diagnostic modalities for this indication as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.