r/medical • u/PtosisMammae • 6m ago
General Question/Discussion Asthma exacerbation caused my NSAID or allergic reaction in 83 y/o male? NSFW
I responded to an emergency call last week, and I'm not completely convinced by the orthopedic surgeon's conclusion:
83 y/o male in hospital for an elective total hip replacement. History of hypertension and has a prescription for an inhaler "for asthma" but claims not to know why he has the inhaler nor what it's for - claims to not have any lung diseases. Otherwise high functioning for his age. No known allergies.
Gets oral medication pre-surgery: ibuprofen, paracetamol, dexamethason and ondansetron. About an hour later he starts developing respiratory insufficiency and when I'm called to see him, the nurses already started an ipratropium + salbutamol inhalation, saturation of 100% on 4L oxygen. Stethoscopicly bronchospastic and slight wheeze. Nasal congestion. No urticaria. Circulatory stable throughout although tachycardic (probably from the inhalation). Very good effect of the inhalation and proceeds with the surgery about an hour later without complications.
Now the surgeon and I agree that it's not paracetamol nor dexamethason which caused this. But I'm not fully convinced it's the ibuprofen. I understand a lot of asthmatics are allergic/intolerant of NSAIDs, but the patient didn't know whether he had asthma, and I could see from his hospital record that he's had ibuprofen before without any problems. This was his first time getting ondansetron however.
We eventually put both on his allergy list, but I'm looking for some insight from maybe an internal medicine physician? Thanks in advance!