Reactive Airway Disease

Question 1

Essentials of Diagnosis:

• is defined as the sudden onset of asthma-like symptoms following high-level exposure to a corrosive gas, vapor, or fumes.
• Most cases are recognized retrospectively, they usually lack accurate assessment of the exposure intensity and objective evidence of prior normal bronchial hyper-responsiveness required for the diagnosis
• Documented absence of preceding respiratory complaint
• Onset after single exposure incident/accident
• Exposure to very high concentration of gas, smoke, fumes, or vapors with irritant properties
• Onset of symptoms within 24 hours after exposure with persistence for at least 3 months
• Symptoms that simulate asthma with cough, wheeze, and dyspnea. Usually manifest within 24 hours of exposure as bronchitis, with ocular or mucus membrane irritation of the upper airway (depending on the agent) and often require emergency treatment.
• Presence of airflow obstruction on pulmonary function ± nonspecific bronchial hyper-responsiveness
• All other pulmonary disease excluded.

Answer 1

Reactive Airway Disease

Question 2

Recognized Causal Agents:

• Household exposure: floor sealants, bleaching agents, household cleaners containing morpholine.
• Chemical: chlorine, sulphuric acid, ammonia, hydrochloric acid, acetic acid, phosgene, organic solvents.
• Industry: paint spraying, welding, heated plastics or acids, epoxy resins, pesticides, industrial cleaning products, dust or molds in silos.
• Other: Fire and smoke inhalation, burning paint fumes, tear gas, locomotive exhaust.

Answer 2

Reactive Airway Disease

Question 3

Physical /Clinical Findings:

• Mucus membrane irritation of the upper airway (depending on the agent) and often require emergency treatment
• Dyspnea
• Cough
• Possible wheezing
• Possible hypoxia

Answer 3

Reactive Airway Disease

Question 4

Labs/Imaging:

• Chest XRAY- may find non-specific findings: inflammation/edema in severe cases.
• Labs- ABG if indicated with severe hypoxia
• PFT’s

Answer 4

Reactive Airway Disease

Question 5

Treatment:

(1) Oxygen if O2
* Sats <95%

(2) Medications
* (a) RADS are less responsive to β2 agonists.
* (b) Oral corticosteroids and bronchodilators SABA commenced within the first 3 months have had the most favorable outcomes.

Answer 5

Reactive Airway Disease

Question 6

Disposition:

• (1) It patient is in no acute distress, without dyspnea, has normal vital signs and is otherwise stable may retain onboard with MO consultation and possible referral to pulmonology and PFT’s.
• (2) If patient is in acute distress, remains unstable, has dyspnea, persistent hypoxia (O2 Sats 95%) then MO call with MEDEVAC is warranted.

Answer 6

Reactive Airway Disease