Dexamethasone aerosol use in an asthmatic nursing-home patient with Parkinson's disease and dementia

Management of asthmatic or emphysematous elderly patients who cannot use metered-dose inhalers with spacers because of severe physical and mental disabilities is difficult. We report a case of a nursing-home patient with dementia and Parkinson's disease who required aerosolized corticosteroids to avoid repeated systemic corticosteroid courses for asthmatic exacerbations. The patient was unable to use a triamcinolone metered-dose inhaler with spacer devices because of his impairments. Therefore, nebulized dexamethasone solution was prepared and administered. Since initiation of nebulized dexamethasone, the patient has not required systemic corticosteroids. In addition, his hypopituitary adrenal axis has remained intact as evidenced by provocative cosyntropin testing. Therefore, nebulized dexamethasone solution may be an alternative to the aerosol corticosteroid metered-dose inhaler when patients are too impaired to use inhalers, even with spacers.