Use of nebulised adrenaline in the management of steroid-resistant stridor.

The patient presented with a one-year history of headaches, a left hemiparesis and a seizure. Investigations revealed multiple cerebral metastases and a lung primary in the left upper lobe with multiple pulmonary metastases. There was no mediastinal lymphadenopathy. Whole brain radiotherapy was given but she was too unwell for any further investigation or treatment to the primary tumour. Stridor was one of her main symptoms and caused her considerable distress. Dexamethasone was prescribed both for the stridor and for headache because of raised intracranial pressure. A dose of 32 mg daily was given due to the concomitant prescription of phenytoin. Despite this, stridor remained an overwhelming symptom. Nebulised 1:1000 adrenaline (epinephrine) was given with immediate relief of the stridor that lasted 2–3 h. We used 1 mL of 1:1000 adrenaline and diluted to a volume of 5 mL with 0.9% saline. The patient experienced no sideeffects. No tachycardia was noted on monitoring her heart rate. Repeating the nebuliser four times each day achieved good symptom control. Although the stridor returned shortly before the next dose of adrenaline was due, it was no longer reported as overwhelming by the patient.