Reactive Airways Dysfunction Syndrome in a Nurse Exposed to Pentamidine

To the Editor: The article by Balmes et al¹ concerning occupational exposure to aerosolized pentamidine demonstrated the respiratory-tract irritant potential of inhaled pentamidine. The authors did not find clinical asthma in any of the subjects of their study, nor was occupational asthma reported in either of the other two studies that they cited, which had looked at the potential adverse health effects of pentamidine exposure among health care workers.

We would like to report a case of Reactive Airways Dysfunction Syndrome, or RADS,² in a 48-year-old nurse after she was acutely exposed to aerosolized pentamidine. The nurse was giving pentamidine through a nebulizer to an AIDS patient as a treatment for Pneumocystis carinii pneumonia when the apparatus leaked and she inhaled the vapor. She immediately experienced difficulty breathing. Her symptoms persisted, and she was placed on asthma medications several months after this exposure. She had no history of asthma or allergies, and had stopped smoking more than 10 years before this exposure. She continued to have lower respiratory tract symptoms. Within a year, she left her job because of her illness. Pulmonary-function testing 2 years after the episode showed a 24% increase in FEV₁ after administration of a bronchodilator. At that time, she was still symptomatic and still taking asthma medications. The patient was reported by a physician (J.W.S.) to the SENSOR^* occupational asthma surveillance system at the New Jersey Department of Health.

This case report underscores the potential for the development of RADS in health care workers after acute exposure to pentamidine, and it complements the finding by Balmes et al of the potential occupational exposure hazards of this medication.

Martha Stanbury, MSPH

Program Manager; New Jersey Department of Health; Trenton, NJ

Eugene Gatti, MD

Marlton NJ

J.W. Sokolowski, MD

Cherry Hill, NJ