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Effect of Mouthwashes on Pulmonary Diffusing Capacity
communicalions 10 Ihe edilor _I~IIII.I-----------======
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Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript.
Sudden Respiratory Arrest from Asthma To the Editor: I wish to describe the abrupt onset of respiratory arrest occurring within ten minutes in a previously well-controlled asthmatic subject. The patient is a 31-year-old businessman, non-smoker, with asthma since infancy. He is maintained on theophylline, terbutaline, and crornolyn sodium. In the weeks prior to his illness, he had occasional wheezing that responded promptly to metaproterenol inhaler. While driving his car, he noted some tightness in the chest. Within one to two minutes, wheezing was audible; he became progressively more dyspneic, began using accessory respiratory muscles, and expiration became prolonged. There was no stridor. Within a few minutes he became cyanotic with gasping respirations. Unconsciousness and apnea ensued. Following administration of 0.4 ml of 1: 1000 epinephrine subcutaneously and mouth-to-mouth ventilation, spontaneous breathing resumed in about two minutes. Subsequent treatment with intravenous aminophylline and aerosolized isoetharine in an emergency room resulted in the total disappearance of symptoms in 90 minutes. Electrocardiogram and roentgenogram of the chest were normal. The occurrence of life-threatening bronchospasm as the only manifestation of an immediate hypersensitivity reaction is rare. Fatal respiratory failure has been reported in asthmatic patients following injection of bromsulphalein 1 and guinea pig hemoglobm.s These patients had marked pulmonary distention, as well as pharyngeal edema at autopsy. Asthmatic patients generally develop respiratory failure over hours to days, not minutes. However, Williams and Levin" reported death from overwhelming bronchial obstruction in a patient whose peak How rate was 120 L/min only one-half hour prior to his demise. Airways have the ability to constrict within minutes to a life-threatening degree, at least in some asthmatic patients.
Elizabeth L. Gabay, M.D., Long Beach, CA REFERENCES
1 Venger N. Fatal reaction to sulfobromophthalein sodium in a patient with bronchial asthma. JAMA 1961; 175: 506-08 2 Hunt EL. Death from allergic shock. N Engl J Med 1943; 228:502-06 3 Williams MH, Levin M. Sudden death from bronchial asthma. Am Rev Respir Dis 1966; 94:608-11
Effect of Mouthwashes on Pulmonary Diffusing Capacity To the Editor: The recent findings on the effects of alcohol on the single breath diffusing capacity for carbon monoxide (DCO Rh ) are interesting observations. 1 ,2 Measurement of DcoSb with the fuel cell method, which is used in many automated pulmonary function laboratories, has been found to be lowered in the presence of alcohol on the patient's breath.! However, Dco s b measured via a gas chromatograph method may or may not be affected by alcohol.t-? If diffusing capacity is found to be abnormally low, it is prudent to question the patient in regard to use of alcohol or alcohol-containing products including mouthwashes prior to the test (Table 1). If a mouthwash was used, it is necessary to determine whether the product contains alcohol. Table 1 lists mouthwashes commonly used and their respective alcohol content.
Vincent P. Cotz, M.S., Assistant Professor, Department of Pharmacy Practice, C oUege of Pharmacy, Un'oersitu of Florida, Gainesville and Robert D. Brandstetter, M.D., Pulmonary Fellow, Pulmonary Unit, Massachusetts General Hospital, Boston REFERENCES
1 Addison TE, Mcflluskey J. Alcohol and the diffusing capacity. Chest 1981; 80: 120 2 Peavy HH, Summer WR, Gurtner G. The effects of alcohol ingestion on pulmonary diffusing capacity. Chest 1980; 77 :488-92 Table I Mouthwash
Alcohol Content
Betadine mouthwash/gargle
8.8%*
Cepacol
14%*t
Cepastat
O%*t
Chloraseptic
o~~*t
Colgate 100 Lavoris Listerine Listerrnint
Scope
15c;~*
5%t 26.9%t
14-15%§ 18.5%*t
"Handbook of Nonprescription Drugs, 6th Ed., Washington, D.C., American Pharmaceutical Association, 1979. [Physicians' Desk Reference for Nonprescription Drugs, 2nd Ed. Oradell, NJ.: ~Iedical Economics Co., 1981. tPersonal correspondence, J. Miller, Vicks Toiletry Products Division, Richardson-Merrell, Inc., \Vilton, CT. §Personal Correspondence, R. Richter, Warner-Lambert Co., Morris Plains, NJ. CHEST I 82 I 3 I SEPTEMBER, 1982
387
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Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript.
Sudden Respiratory Arrest from Asthma To the Editor: I wish to describe the abrupt onset of respiratory arrest occurring within ten minutes in a previously well-controlled asthmatic subject. The patient is a 31-year-old businessman, non-smoker, with asthma since infancy. He is maintained on theophylline, terbutaline, and crornolyn sodium. In the weeks prior to his illness, he had occasional wheezing that responded promptly to metaproterenol inhaler. While driving his car, he noted some tightness in the chest. Within one to two minutes, wheezing was audible; he became progressively more dyspneic, began using accessory respiratory muscles, and expiration became prolonged. There was no stridor. Within a few minutes he became cyanotic with gasping respirations. Unconsciousness and apnea ensued. Following administration of 0.4 ml of 1: 1000 epinephrine subcutaneously and mouth-to-mouth ventilation, spontaneous breathing resumed in about two minutes. Subsequent treatment with intravenous aminophylline and aerosolized isoetharine in an emergency room resulted in the total disappearance of symptoms in 90 minutes. Electrocardiogram and roentgenogram of the chest were normal. The occurrence of life-threatening bronchospasm as the only manifestation of an immediate hypersensitivity reaction is rare. Fatal respiratory failure has been reported in asthmatic patients following injection of bromsulphalein 1 and guinea pig hemoglobm.s These patients had marked pulmonary distention, as well as pharyngeal edema at autopsy. Asthmatic patients generally develop respiratory failure over hours to days, not minutes. However, Williams and Levin" reported death from overwhelming bronchial obstruction in a patient whose peak How rate was 120 L/min only one-half hour prior to his demise. Airways have the ability to constrict within minutes to a life-threatening degree, at least in some asthmatic patients.
Elizabeth L. Gabay, M.D., Long Beach, CA REFERENCES
1 Venger N. Fatal reaction to sulfobromophthalein sodium in a patient with bronchial asthma. JAMA 1961; 175: 506-08 2 Hunt EL. Death from allergic shock. N Engl J Med 1943; 228:502-06 3 Williams MH, Levin M. Sudden death from bronchial asthma. Am Rev Respir Dis 1966; 94:608-11
Effect of Mouthwashes on Pulmonary Diffusing Capacity To the Editor: The recent findings on the effects of alcohol on the single breath diffusing capacity for carbon monoxide (DCO Rh ) are interesting observations. 1 ,2 Measurement of DcoSb with the fuel cell method, which is used in many automated pulmonary function laboratories, has been found to be lowered in the presence of alcohol on the patient's breath.! However, Dco s b measured via a gas chromatograph method may or may not be affected by alcohol.t-? If diffusing capacity is found to be abnormally low, it is prudent to question the patient in regard to use of alcohol or alcohol-containing products including mouthwashes prior to the test (Table 1). If a mouthwash was used, it is necessary to determine whether the product contains alcohol. Table 1 lists mouthwashes commonly used and their respective alcohol content.
Vincent P. Cotz, M.S., Assistant Professor, Department of Pharmacy Practice, C oUege of Pharmacy, Un'oersitu of Florida, Gainesville and Robert D. Brandstetter, M.D., Pulmonary Fellow, Pulmonary Unit, Massachusetts General Hospital, Boston REFERENCES
1 Addison TE, Mcflluskey J. Alcohol and the diffusing capacity. Chest 1981; 80: 120 2 Peavy HH, Summer WR, Gurtner G. The effects of alcohol ingestion on pulmonary diffusing capacity. Chest 1980; 77 :488-92 Table I Mouthwash
Alcohol Content
Betadine mouthwash/gargle
8.8%*
Cepacol
14%*t
Cepastat
O%*t
Chloraseptic
o~~*t
Colgate 100 Lavoris Listerine Listerrnint
Scope
15c;~*
5%t 26.9%t
14-15%§ 18.5%*t
"Handbook of Nonprescription Drugs, 6th Ed., Washington, D.C., American Pharmaceutical Association, 1979. [Physicians' Desk Reference for Nonprescription Drugs, 2nd Ed. Oradell, NJ.: ~Iedical Economics Co., 1981. tPersonal correspondence, J. Miller, Vicks Toiletry Products Division, Richardson-Merrell, Inc., \Vilton, CT. §Personal Correspondence, R. Richter, Warner-Lambert Co., Morris Plains, NJ. CHEST I 82 I 3 I SEPTEMBER, 1982
387