Users Online: 552 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to [email protected] preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 36  |  Issue : 3  |  Page : 412-413

SARS- CoV-2 infection presented as acute exacerbation of bronchial Asthma


Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

Date of Submission07-Jul-2020
Date of Acceptance16-Jul-2020
Date of Web Publication15-Sep-2020

Correspondence Address:
Dr. Souvik Maitra
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Ansari Nagar, Room No: 5011, Teaching Block, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_414_20

Rights and Permissions

How to cite this article:
Raina P, Baidya DK, Anand RK, Ray BR, Subramaniam R, Maitra S. SARS- CoV-2 infection presented as acute exacerbation of bronchial Asthma. J Anaesthesiol Clin Pharmacol 2020;36:412-3

How to cite this URL:
Raina P, Baidya DK, Anand RK, Ray BR, Subramaniam R, Maitra S. SARS- CoV-2 infection presented as acute exacerbation of bronchial Asthma. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2020 Nov 29];36:412-3. Available from: https://www.joacp.org/text.asp?2020/36/3/412/295109

Dear Editor,

The varied presentation of acute respiratory illness from SARS-CoV-2 poses a diagnostic challenge to the physician. The classic presentation of fever, cough and shortness of breath is often not reported in a number of patients. We report a case of acute respiratory illness in a middle-aged asthmatic man who presented with acute severe bronchospasm.

A 59-year-old male patient presented in emergency department with a history of shortness of breath for 5 days and he was immediately shifted to the screening intensive care unit (ICU) as dyspnea was rapidly increasing. He was a known case of bronchial asthma for 4 months and type 2 diabetes for 2 years, on regular medical management. He denied any history of fever and cough or any relevant contact history. On arrival in the ICU, he was conscious and oriented, but dyspneic, using accessory muscles of respiration with respiratory rate of 28 per minute and maintaining SpO2 of 86% on room air. The rest of the hemodynamic parameters were stable. Lung ultrasonography showed B profile in zone 1 of right lung with shredding. The other lung zones were normal. Oxygen supplementation by face mask, and nebulization with salbutamol were started and intravenous hydrocortisone 100 mg was administered. Nasal and throat swabs were sent for real time polymerase chain reaction (RT-PCR) for SARS-CoV-2 identification. However, despite of medical management, respiratory rate increased to 40 and SpO2 decreased to 65-70% and altered sensorium was also noted. Immediately, endotracheal intubation was performed by videolaryngoscope after administering intravenous propofol 2 mg/kg and rocuronium 1.2 mg/kg. Mechanical ventilation was initiated by volume-controlled ventilation with a tidal volume of 350 ml, respiratory rate of 18/m and an initial PEEP of 5 cm H2O. A peak airway pressure of 45 cm H2O and a plateau airway pressure of 25 cm H2O was noted which further supported the diagnosis of acute bronchospasm. Intravenous magnesium sulphate of 2 gm administered followed by intravenous ketamine infusion which decreased peak airway pressure to 35 cm H2O and SpO2 increased to 95%. RT- PCR revealed that the patient was infected with SARS-CoV-2.

Viral respiratory infections are often implicated as an inciting event for acute exacerbation of bronchial asthma[1] and asthma is associated with adverse outcome in patients with viral respiratory infection.[2] SARS-CoV-2 exhibited a diverse range of clinical symptoms including the classic triad of fever, cough and shortness of breath.[3] However, majority of the large series did not actually mention the proportion of asthmatic patients who were infected with SARS-COV-2.[4] Richardson et al. mentioned 9% of the cases had bronchial asthma as a comorbidity but the presentation as acute exacerbation of asthma was not described.[5] The presentation in our patient was unique, as he presented with only rapidly progressive dyspnea without any other clinical feature. In the era of current pandemic, SARS-CoV-2 must be kept as a differential diagnosis in any patient who is presenting with acute exacerbation of asthma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Camargo CA Jr, Rachelefsky G, Schatz M. Managing asthma exacerbations in the emergency department: Summary of the National Asthma education and prevention program expert panel report 3 guidelines for the management of asthma exacerbations. J Allergy Clin Immunol 2009;124(2 Suppl):S5-14.  Back to cited text no. 1
    
2.
Jackson DJ, Trujillo-Torralbo MB, del-Rosario J, Bartlett NW, Edwards MR, Mallia P, et al. The influence of asthma control on the severity of virus-induced asthma exacerbations. J Allergy Clin Immunol 2015;136:497-500.  Back to cited text no. 2
    
3.
Day M. Covid-19: Four fifths of cases are asymptomatic, China figures indicate. BMJ 2020;369:m1375.  Back to cited text no. 3
    
4.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region-Case series. N Engl J Med 2020;382:2012-22.  Back to cited text no. 4
    
5.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities and outcomes among 5700 patients hospitalized with COVID-19 in New York city area. JAMA 2020;323:2052-9.  Back to cited text no. 5
    




 

Top
 
  Search
 
    Similar in PUBMED
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed225    
    Printed10    
    Emailed0    
    PDF Downloaded25    
    Comments [Add]    

Recommend this journal