Possible Association of Benzalkonium Chloride in Nebulizer Solutions with Respiratory Arrest

OBJECTIVE: To report a case of possible association of benzalkonium chloride in nebulizer solutions with respiratory arrest and to review the involvement of various preservative agents in paradoxical bronchoconstrictive reactions. DATA SOURCES: Reference articles, case reports, and editorials are identified in the text. DATA SYNTHESIS: Many pharmacologic agents are available for nebulization. In addition to the active drug, these nebulizer solutions may contain preservatives. We describe a case of respiratory arrest in a 64-year-old man following nebulization therapy with albuterol and ipratropium solutions. These solutions contain benzalkonium chloride as a preservative. We are aware of only one report describing two deaths associated with such a severe reaction attributable to nebulization therapy. However, many reports of milder paradoxical bronchoconstriction are available in the medical literature. CONCLUSIONS: Clinicians should be aware of the possibility of paradoxical bronchoconstrictive reactions when patients are treated with nebulized bronchodilators.