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Ten puffs too many
  1. R Patel,
  2. S J Potter
  1. Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK;

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An 11 year old boy with chronic asthma was discovered to have multiple burn marks to the dorsum of his left hand. Initial presentation to the GP surgery was for another reason and these findings were noted on examination (fig).

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On questioning the boy about the marks he boastfully replied that they were obtained by repeatedly firing his salbutamol MDI (metered dose inhaler) with the nozzle placed directly against his skin; firing up to 10 times at any one go. This was an activity that he had adopted with his school friends at break time, competing to see who could tolerate the most.

Small localised burns are commonly seen with a varied aetiology. Self inflicted burns are well described in the burns literature.1 These are mainly due to attempted self harm. A literature search showed only one reported case of a 22 year old woman, who deliberately discharged 40 blasts of her salbutamol, resulting in a 3 cm diameter full thickness burn.2

On contacting the manufacturer of salbutamol MDI, they reported no such incidents and had no evidence to believe that the use of the constituents can lead to burns when applied topically. Suggested mechanisms of injury have been:2

  • A chemical burn from the pharmaceutical/preservative/propellant aerosol

  • A burn due to the physical effect of severe cooling of the skin

  • Mechanical abrasive effect of the aerosol blasts

  • Combination of some or all the above mechanisms.

This interesting case highlights the importance of education on the appropriate use of inhaler devices. We should also remind parents and children of the hazards of pressurised aerosols.