Ipratropium-induced bronchospasm in a Chronic Obstructive Pulmonary
Disease patient-a rare and serious clinical vignette of altered drug
response: a case report
Abstract
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.