Abstract

The medical history included bronchial asthma from the age of 10 years and positive skin test results for mites. The family history was positive for allergic asthma. Immunotherapy for mites was performed from the age of 16 to the age of 20 but did not provide significant benefits. The patient had no known drug sensitivities, history of aspirin-induced asthma, or food allergy. He had never been hospitalized for treatment of severe asthma attacks. He had been treated irregularly with inhaled beclomethasone and fenoterol. In April 1992 he started regular therapy with inhaled beclomethasone 500 Iug twice daily, inhaled salmeterol 50 Iug twice daily, and fenoterol on an as-needed basis. In June 1992, he was referred to the pulmonary
function laboratory for assessment of the degree of airway responsiveness to ultrasonically nebulized distilled water. At that time he was free of symptoms, and
his baseline spirometry demonstrated normal lung volumes (forced expiratory volume in 1 second = 85% of predicted value and forced expiratory volume in 1 second/vital capacity = 88%). After spirometry was performed, he was invited to inhale ultrasonically nebulized distilled water through a rubber face mask. One minute after the beginning of the inhalation, a severe asthma attack occurred and progressed so rapidly that it could not be reversed by prompt treatment with salbutamol 10 puffs, oxygen therapy, methylprednisolone 200 mg administered intravenously, epinephrine 2 mg administered subcutaneously, and mechanical ventilation. During the treatment he also had an episode of vomiting. Within 15
minutes of the beginning of the attack the patient was dead. https://doi.org/10.1016/S0091-6749(95)70088-9

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