title: Nebulised N-acetylcysteine used in acute tracheostoma obstruction.
abstract: BACKGROUND
  Patients with laryngectomy tracheostomas are at risk of developing acute airway obstruction due to mucous crusting. Current management relies on saline nebulisers, followed by suction and manual evacuation to remove the obstruction. This paper describes the first reported case of using N-acetylcysteine nebulisers in addition to saline to adequately soften the mucous plugs in order to facilitate removal.
  
  
  METHODS
  A 68-year-old female attended the emergency department with a partial obstruction of her laryngectomy tracheostoma as a result of mucous crusting. Saline nebulisers did not provide adequate softening to allow the obstructing mucous plugs to be removed. N-acetylcysteine nebulisers were used to further soften the mucous plugs which successfully resulted in their removal.
  
  
  CONCLUSIONS
  N-acetylcysteine nebulisers can be used to assist in the removal of mucous plugs in saline-resistant cases.
authors.affiliation: ENT Department,Lewisham Hospital,London,UK.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: ENT Department,Lewisham Hospital,London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Theokli
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000368:Aged; D000402:Airway Obstruction / Q000188:drug therapy* / Q000209:etiology*; D004359:Drug Therapy, Combination / Q000379:methods; D005100:Expectorants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods; D009093:Mucus / Q000187:drug effects; D009330:Nebulizers and Vaporizers; D012965:Sodium Chloride / Q000008:administration & dosage; D014139:Tracheostomy / Q000009:adverse effects*
chemical_list: D005100:Expectorants; D012965:Sodium Chloride; D000111:Acetylcysteine