Subcutaneous Emphysema in Bronchial Asthma

CASE REPORT. A man, aged 28 years, developed an attack of asthma on 8th October, 1955. He had been subject to asthmatic attacks from early infancy. The attacks had been recurring with decreasing frequency, and the previous severe attack was five years previously. Treatment at home failed to relieve his symptoms, and he was admitted to hospital on 12th October, 1955. On examination, he was in acute respiratory distress. He was sitting upright, sweating profusely, cyanosed, and gasping for breath. The left side of the face was swollen. There was marked subcutaneous emphysema about the neck, and over the anterior chest wall. The air entry was poor, with marked prolongation of expiration. There were no crackling rales along the mediastinal border or synchronous with the heart beat. The blood pressure was 130/80. The pulse rate was 120 per minute and regular. X-ray chest revealed subcutaneous emphysema in the supraclavicular regions. There was no evidence of pneumothorax or mediastinal emphysema. He was treated with intravenous aminophylline, adrenaline hydrochloride. (1: 1,000) subcutaneously, and prednisolone. Within forty-eight hours he had improved considerably. The emphysema gradually subsided, and he was discharged home after two weeks in hospital.