Parmar Malvinder S
Timmins & District Hospital, Medicine, Suite E, 640 Ross Avenue East, Timmins, Ontario, P4N 8P2, Canada.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.10.2008.1062. Epub 2009 Mar 17.
Asthma is a common chronic inflammatory disorder of the airways associated with hyperresponsiveness, reversible airflow limitation and respiratory symptoms.1 All patients with asthma are at risk for exacerbations that may range from mild to life threatening. Different triggers cause asthma exacerbation by inducing airway inflammation and/or provoking bronchospasm. Allergen-induced bronchospasm results from IgE-dependent release of mediators including histamine, prostaglandins and leukotrienes.2 Opiates are commonly used to treat chronic pain.3 Although hypersensitivity to opiates or accumulation of opiates can cause respiratory depression, opiates are also used in the management of cough and dyspnoea associated with advanced COPD and heart failure.4(,)5 Here, a report is presented on a patient who developed persistent exacerbation of underlying stable asthma after initiating fentanyl transdermal therapy for chronic low back pain. He underwent extensive investigations and a detailed reassessment of history, especially medication history, led to the possible causative factor; once recognised, removal of the offending agent (fenatnyl) resulted in complete improvement in his symptoms within 72 h.
哮喘是一种常见的气道慢性炎症性疾病，伴有高反应性、可逆性气流受限和呼吸道症状。所有哮喘患者都有病情加重的风险，严重程度可从轻度到危及生命。不同的触发因素通过诱发气道炎症和/或引发支气管痉挛导致哮喘加重。变应原诱导的支气管痉挛是由包括组胺、前列腺素和白三烯在内的介质的IgE依赖性释放引起的。阿片类药物常用于治疗慢性疼痛。虽然对阿片类药物过敏或阿片类药物蓄积可导致呼吸抑制，但阿片类药物也用于治疗与晚期慢性阻塞性肺疾病（COPD）和心力衰竭相关的咳嗽和呼吸困难。在此，报告了一名患者，该患者在开始使用芬太尼透皮贴剂治疗慢性下腰痛后，基础稳定的哮喘持续加重。他接受了广泛的检查，对病史，尤其是用药史进行了详细的重新评估，找到了可能的致病因素；一旦识别出来，停用致病药物（芬太尼）后，他的症状在72小时内完全改善。
