Virginia Research Day 2025

Medical Resident Research Case Reports

09 Adenosine Induced Chronic Obstructive Pulmonary Disease Exacerbation

Mathilde Djiogan, D.O. 1 ; Jordan Nolan D.O. 2 ; Kimberly Bird, M.D. 3 ; Fahid Alghanim, M.D. 4 Corresponding author: jordan.nolan@lpnt.net

1,2 Department of Internal Medicine, Sovah Health Danville, Virginia 3,4 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sovah Health Danville, Virginia

Adenosine is a drug that works by triggering the potassium channels through the A1 receptor on cardiac cells which slows the rate thereby affecting the AV node conduction delay. It is commonly used to treat narrow complex tachyarrhythmias. There are some contraindications to consider when administering adenosine such as symptomatic bradycardia, second- or third-degree AV block, and bronchoconstrictive disorders since it can lead to adverse effects of dyspnea, facial flushing, and chest pain. These effects are usually transient since adenosine has a half-life of less than 10 seconds. The case details the effect of adenosine in a patient with chronic obstructive pulmonary disease. Case: A 64-year-old African American male with past medical history of hypertension, hyperlipidemia, paroxysmal atrial fibrillation on Eliquis, COPD, emphysema, tobacco dependence, and prostate cancer presents to the emergency room due to cardiac arrest after bronchoscopy with transbronchial biopsy

for evaluation of multiple pulmonary nodules. Chest x-ray was obtained which showed bilateral pneumothoraxes which necessitated right chest tube and left pigtail thoracostomy tube insertion. The patient initially required invasive mechanical ventilation for airway support but was later extubated. During the hospital stay, the patient was noted to have narrow complex tachycardia. Adenosine 6mg was administered. The patient experienced transient improvement in heart rate with atrial flutter noted on rhythm strip. Amiodarone bolus 150mg and metoprolol 5mg IV were administered with persistent elevation in heart rate. Therefore, synchronized cardioversion at 200 J was performed with marked improvement in heart rate. After cardioversion, the patient was noted to be in respiratory distress with diffuse expiratory wheezing on examination. He was placed on BIPAP for respiratory support and started on bronchodilators and steroids for suspected COPD exacerbation.

Discussion: This case highlights that adenosine can cause bronchospasm leading to COPD exacerbation. Prior studies suggest the effect of adenosine in COPD patients were observed only in rare instances and symptoms were usually augmented in case of active bronchospasm. Though the patient was not in COPD exacerbation during adenosine administration, its use should not be discouraged in narrow complex tachycardia. In the case detailed above, the patient was noted to have atrial flutter on rhythm strip following adenosine administration and later became unstable necessitating cardioversion. Conclusion: In summary, the case report demonstrates that caution must be exercised prior to the administration of adenosine in patients with COPD to prevent exacerbation.

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