News

Monday, 31. March 2014

Case Report: successful nebulization with tissue plasminogen activator in plastic bronchitis therapy

inhalation (e.g. with salbutamol, budenoside, DNase or acetylcysteine) is often an important component of therapy [1].

Plastic bronchitis is a rare serious, sometimes fatal complication often associated with primary respiratory diseases and concomitant heart surgeries and is characterized by formation of large, branching bronchial casts [1]. In addition to the symptomatic acute treatment, and often life-saving bronchoscopy to remove the bronchial casts, inhalation (e.g. with salbutamol, budenoside, DNase or acetylcysteine) is often an important component of therapy [1].  


Possible primary diseases for bronchial casts
AsthmaDiseases of lymphs
Allergic bronchopulmonary aspergillosisSickle-cell disease
Bronchocentric granulomatosisHeart faillure
BronchiectasisConstrictive pericarditis
Cystic fibrosisPericardial effusion
TuberculosisMitral valve stenosis
DiphtheriaRheumatoid arthritis
Amyloidosis
Pseudomembranous colitis

Tab. 1: Possible primary diseases for bronchial casts [1]

A successful therapy with the nebulized tissue plasminogen activator (t-PA) Alteplase in plastic bronchitis is documented in the case report of M. Colaneri et al. A 13-year-old boy who suffers from primary ciliary dyskinesia and congenital heart disease developed a chronic oto-sino-pulmonary disease after a heart surgery. Exacerbations of his heart- and lung function demanded a hospitalisation including extubation, ventilation and bronchoscopy. Due to the failure of the initiated treatment with nebulized salbutamol, N-acetylcysteine, budesonide, DNase and oral sildenafil an additional inhalation with t-PA was induced (via the PARI LC SPRINT nebulizer). By thus a therapeutical success could be reached within the next few days since the bronchial secretions became thinner and respiratory symptoms did not recurred. The patient was discharged home receiving the recommendation to continue the inhalation with budesonide, DNase, t-PA and oral sildenafil in combination with physiotherapy.

[1] Schmitz J et al.  2004, Pneumologie; 58: 443-448
[2] Colaneri M et al.  2014, Italian Journal of Pediatrics, 40:18