Severe asthma exacerbation induced by N-acetylcysteine: case report

Abstract

Background: N-acetylcysteine (NAC) is a drug used to break up the mucus and facilitate the expectoration of sputum. NAC is generally known as a safe drug. Adverse reactions to NAC are defined as ‘‘anaphylactoid’’ and include urticaria rash, vomiting, flushing, angioedema and hypotension. The reactions usually are mild and dose-related, manifest after intravenous administration. It has been occasionally reported NAC induced bronchospasm, probably due to local histamine release. Case report: We report the case of a 73- year-old man who developed status asthmaticus after use of oral NAC. The patient was admitted to Intensive Care Unit with dyspnoea, wheezing and coughs following ingestion of 600 mg of NAC. He had 15 years history of aspirin-induced asthma. So far he had tolerated analgesics such as paracetamol. Physical examination did not show any rash or hypotension, but chest auscultation revealed severe bilateral wheeze with poor chest expansion. Routine blood tests (differential blood count, creatinin, glucose) and chest X-ray were normal. Total serum IgE was elevated (299 kU/L). [...].