Treasure in the chest

Abstract

A 41-year-old woman with a background of asthma was preparing for a party on New Year's Eve when she developed a mild wheeze. Concerned her symptoms would develop and impact on festivities, she located her uncapped salbutamol inhaler in her handbag. Ignoring the coarse rattle as she shook it, she proceeded to take a deep inspiration. Instantly, she felt a painful scratch in her pharynx followed by a harsh cough, which persisted over the next few minutes and became associated with haemoptysis. She was taken to the accident and emergency department. Chest X-ray revealed a radiodense foreign body in the distal right main bronchus. During endoscopy, an earring, causing subtotal occlusion in the right lower lobe bronchus was found and extracted. Her observations remained within normal limits throughout. The importance of replacing caps on inhalers when not in use is illustrated and should be encouraged when inhaler technique is taught or reviewed.