Choking after inhaling a foreign body through a Ventolin puffer

To the Editor:

A 10-year-old boy awoke with asthma. His mother, also an asthmatic, took her salbutamol inhaler from her purse and gave the boy a puff. The boy immediately became extremely distressed and was unable to speak. He mouthed to his mother, "I cannot breathe". His mother performed the Heimlich manoeuvre, during which a white object was expelled from the boy's mouth, immediately relieving his distress. The object was a cigarette filter.

His mother is a cigarette smoker and rolls her own cigarettes. Loose cigarette filters and uncapped asthma inhalers were found in the clutter at the bottom of her purse (Figure). As she had previously propelled a filter into her own airway from an inhaler, with less severe consequences, she recognised the likely cause of her son's sudden inability to breathe.

This frightening and potentially lethal episode illustrates the importance of keeping caps on asthma aerosol inhalers when not in use, so preventing objects from lodging in the aerosol mouthpieces.

Michael J Mackay
Senior Medical Officer, Emergency Department, Mackay Base Hospital
Bridge Road, Mackay, QLD 4741