Bronchospasm

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prashanth Saddala M.B.B.S.; Areej Tariq

Overview

Bronchospasm is a difficulty in breathing caused by a sudden constriction of the muscles in the walls of the bronchioles.

Pathophysiology

Bronchospasm is caused by the release (degranulation) of substances from mast cells or basophils under the influence of anaphylatoxins. The overactivity of the bronchioles' muscle is a result of exposure to a stimulus which under normal circumstances would cause little or no response. The resulting constriction and inflammation causes a narrowing of the airways and an increase in mucus production; this reduces the amount of oxygen that is available to the individual causing breathlessness, coughing and hypoxia.

Inflamed airways and bronchoconstriction in asthma. Airways narrowed as a result of the inflammatory response cause wheezing.

Causes

Common Causes

• Allergens such as eggs, milk, peanuts, walnuts, tree and other nuts, fish, especially shellfish, soy and wheat; insect bites and stings, especially bee stings; and other medicines, especially penicillin and its derivatives.
• Anaphylaxis
• Asthma
• Beta-blockers
• Bronchitis
• Cold air
• COPD
• Decongestants
• Endotracheal tube placement
• LRTI
• URTI

Causes by Organ System

Cardiovascular	Churg-Strauss syndrome, Anaphylactic shock
Chemical / poisoning	5-Hydroxyindoleacetic acid, Alanycarb, Aldicarb, Aldoxycarb, Allyxycarb, Amidithion, Aminocarb, Amiton, Anaphylatoxin, Athyl-Gusathion, Azinfosethyl, Azinfos-methyl, Azinophos-methyl, Azinphos, Azinphos-ethyl, Azinphos-methyl, Azinphosmetile, Azothoate, Bendiocarb, Benfuracarb, Benoxafos, Bromophos, Bromophos-ethyl, Snake bite, Bufencarb, Butacarb, Butocarboxim, Butoxcarboxim, Cadusafos, Carbamates, Carbaryl, Carbofuran, Carbophenothion, Carbosulfan, Caterpillar poisoning, Chlorfenvinphos, Chlorine Dioxide, Chloroacetophenone, Chlorobenzylidene Malononitrile, Chloropyrifos, Chlorpyrifos methyl, Cloethocarb, CS gas, Cyanthoate, Decarbofuran, Demeton, Demeton-methyl, Demeton-O, Demeton-O-methyl, Demeton-S-methyl, Demeton-S-methylsulphon, Dialifos, Diazinon, Dichlorvos, Dicresyl, Dicrotophos, Dimetan, Dimethoate, Dimetilan, Dioxacarb, Dioxathion, Disulfoton, EMPC, Endothion, Ethiofencarb, Ethion, Ethoate-methyl, Ethoprophos, Ethyl-guthion, Etrimfos, Eucalyptus oil , Fenchlorphos, Fenethacarb, Fenitrothion, Fenobucarb, Fensulfothion, Fenthion, Fonophos, Formothion, Furathiocarb, Gonionemus poisoning, Guthion (ethyl), Heptenophos, Hydrogen sulfide, Hyquincarb, Iodofenphos, Isofenphos, Isoprocarb, Latex allergy, Malathion, Mecarbam, Methacrifos, Methamidophos, Methidathion, Methiocarb, Methomyl, Methylene Diisocyanate, Metiltriazotion, Metolcarb, Mevinphos, Mexacarbate, Monocrotophos, Monosodium glutamate, Nitrilacarb, Nitrogen dioxide, Nitromethane, Omethoate, Organophosphates, Oxamyl, Oxydeprofos, Oxydisulfoton, Parathion, Parathion Methyl, Phenkapton, Phorate, Phosalone, Phosdrin, Phosmet, Phosphamidon, Phoxim, Pirimicarb, Pirimiphos-methyl, Platinum salts, Primiphos methyl, Profenofos, Promacyl, Promecarb, Propoxur, Prothidathion, Prothoate, Pyrimitate, Quinalphos, Quintiofos, Radiocontrast, Scombroid, Smoke inhalation, Sophamide, Sulfotep, Sulfur Trioxide, Tazimcarb, Terbufos, Tetraethyl Pyrophosphate, Tetrodotoxin, Thiocarboxime, Thiodicarb, Thiofanox, Thiometon, Tolclofos methyl, Toluene Diisocyanate, Triazophos, Triazotion, Trifenfos, Trimethacarb, Vamidothion, XMC, Xylylcarb, Analgesic asthma syndrome
Dermatologic	No underlying causes
Drug Side Effect	Abciximab, Acetylcysteine, Acetylsalicylic acid, Adenosine, Alemtuzumab, Aspirin, Atenolol, Atracurium, Benzonatate, Beta-blockers, Betahistine, Betaxolol, Bethanechol, Cocaine, Colistin, Cyclizine, Diclofenac, Felbinac, Hydroxyethyl starch, Ibritumomab tiuxetan, Ibuprofen, Indometacin, Ketamine, Ketorolac, Labetalol, Nadolol, Nitrazepam, NSAIDs, Penicillin, Pentamidine, Pilocarpine, Propafenone, Propranolol, Rapacuronium, Streptokinase, Timolol, Zanamivir, Decongestants, Oxymetazoline, Phenylephrine
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Byssinosis, Pollen allergy
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Hypereosinophilic syndrome, Mastocytosis
Iatrogenic	Blood transfusion, Bronchial challenge test, Exercise stress testing
Infectious Disease	Pfiesteria piscicida , Pneumonia, Schistosomiasis, Pulmonary eosinophilia, Pulmonary strongyloidiasis, Viral illness, Visceral larva migrans, Allergic bronchopulmonary aspergillosis, Bronchiolitis, LRTI, URTI, Giardiasis
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Carcinoid tumour
Opthalmologic	No underlying causes
Overdose / Toxicity	Abciximab, Acetylcysteine, Acetylsalicylic acid, Adenosine, Alemtuzumab, Aspirin, Atenolol, Atracurium, Benzonatate, Beta-blockers, Betahistine, Betaxolol, Bethanechol, Cocaine, Colistin, Cyclizine, Diclofenac, Felbinac, Hydroxyethyl starch, Ibritumomab tiuxetan, Ibuprofen, Indometacin, Ketamine, Ketorolac, Labetalol, Nadolol, Nitrazepam, NSAIDs, Penicillin, Pentamidine, Pilocarpine, Propafenone, Propranolol, Rapacuronium, Streptokinase, Timolol, Zanamivir, Decongestants, Oxymetazoline, Phenylephrine
Psychiatric	No underlying causes
Pulmonary	Shaver's disease, Allergic bronchopulmonary aspergillosis, Asthma, Bronchiolitis, Bronchopulmonary dysplasia, Emphysema, Churg-Strauss syndrome, Analgesic asthma syndrome, Pneumonia, Pulmonary strongyloidiasis, Aspiration, Byssinosis, COPD, LRTI, URTI
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Anaphylaxis, Food allergy, Peanut allergy, Pollen allergy, Latex allergy, Anaphylactic shock
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Anaphylaxis, Anaphylactic shock, Aspiration, Exercise induced bronchospasm, Food allergy, Clove cigarette smoking, Near-drowning, Peanut allergies, Carcinoid syndrome, Snake bite, Latex allergy, Pollen allergy, Cocaine

Causes in Alphabetical Order

5-Hydroxyindoleacetic acid Abciximab Acetylcysteine Acetylsalicylic acid Adenosine Alanycarb Aldicarb Aldoxycarb Alemtuzumab Allergic bronchopulmonary aspergillosis Allyxycarb Amidithion Aminocarb Amiton Analgesic asthma syndrome Anaphylactic shock Anaphylatoxin Anaphylaxis Aspiration Aspirin Asthma Atenolol Athyl-Gusathion Atracurium Azinfosethyl Azinfos-methyl Azinophos-methyl Azinphos Azinphos-ethyl Azinphos-methyl Azinphosmetile Azothoate Bendiocarb Benfuracarb Benoxafos Benzonatate Beta-blockers Betahistine Betaxolol Bethanechol Blood transfusion Bromophos Bromophos-ethyl Bronchial challenge test Bronchiolitis Bronchopulmonary dysplasia Bufencarb Butacarb Butocarboxim Butoxcarboxim Byssinosis Cadusafos Carbamates Carbaryl Carbofuran Carbophenothion Carbosulfan Carcinoid syndrome Carcinoid tumour Caterpillar poisoning Chlorfenvinphos Chlorine Dioxide Chloroacetophenone Chlorobenzylidene Malononitrile Chloropyrifos Chlorpyrifos methyl Churg-Strauss syndrome Cloethocarb Clove cigarette smoking Cocaine Colistin COPD CS gas Cyanthoate Cyclizine Decarbofuran Decongestants

Demeton Demeton-methyl Demeton-O Demeton-O-methyl Demeton-S-methyl Demeton-S-methylsulphon Dialifos Diazinon Dichlorvos Diclofenac Dicresyl Dicrotophos Dimetan Dimethoate Dimetilan Dioxacarb Dioxathion Disulfoton EMPC Emphysema Endothion Ethiofencarb Ethion Ethoate-methyl Ethoprophos Ethyl-guthion Etrimfos Eucalyptus oil Exercise induced bronchospasm Exercise stress testing Felbinac Fenchlorphos Fenethacarb Fenitrothion Fenobucarb Fensulfothion Fenthion Fonophos Food allergy Formothion Furathiocarb Giardiasis Gonionemus poisoning Guthion (ethyl) Heptenophos Hydrogen sulfide Hydroxyethyl starch Hypereosinophilic syndrome Hyquincarb Ibritumomab tiuxetan Ibuprofen Indometacin Iodofenphos Isofenphos Isoprocarb Ketamine Ketorolac Labetalol Latex allergy LRTI Malathion Mastocytosis Mecarbam Methacrifos Methamidophos Methidathion Methiocarb Methomyl Methylene Diisocyanate Metiltriazotion Metolcarb Mevinphos Mexacarbate Monocrotophos Monosodium glutamate Nadolol Near-drowning Nitrazepam

Nitrilacarb Nitrogen dioxide Nitromethane NSAIDs Omethoate Organophosphates Oxamyl Oxydeprofos Oxydisulfoton Oxymetazoline Parathion Parathion Methyl Peanut allergies Penicillin Pentamidine Pfiesteria piscicida Phenkapton Phenylephrine Phorate Phosalone Phosdrin Phosmet Phosphamidon Phoxim Pilocarpine Pirimicarb Pirimiphos-methyl Platinum salts Pneumonia Pollen allergy Primiphos methyl Profenofos Promacyl Promecarb Propafenone Propoxur Propranolol Prothidathion Prothoate Pulmonary eosinophilia Pulmonary strongyloidiasis Pyrimitate Quinalphos Quintiofos Radiocontrast Rapacuronium Schistosomiasis Scombroid Shaver's disease Smoke inhalation Snake bite Sophamide Streptokinase Sulfotep Sulfur Trioxide Tazimcarb Terbufos Tetraethyl Pyrophosphate Tetrodotoxin Thiocarboxime Thiodicarb Thiofanox Thiometon Timolol Tolclofos methyl Toluene Diisocyanate Triazophos Triazotion Trifenfos Trimethacarb URTI Vamidothion Viral illness Visceral larva migrans XMC Xylylcarb Zanamivir

Treatment

Pharmacotherapy

Beta 2 agonists

Beta 2 adrenergic agonists are recommended for bronchospasm.

• Short acting (SABA)
  • Salbutamol
  • Levosalbutamol
• Long acting (LABA)
  • Formoterol
  • Salmeterol
• Others
  • Dopamine
  • Norepinephrine
  • Epinephrine

Muscarinic Acetylcholine receptor antagonist

Since the neurotransmitter, acetylcholine, is known to decrease sympathetic response by slowing the heart rate and constricting the smooth muscle tissue; ongoing research and successful clinical trials have shown that agents such as diphenhydramine, atropine and Ipratropium bromide is known to be effective for treating asthma and COPD-related symptoms.

References

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