Improved pulmonary function after inhalation Rx with dabigat
The present case has been published in BMJ. Accidental long-term dabigatran etexilate inhalation was associated with subtherapeutic dabigatran serum concentrations in an elderly female patient with restrictive lung disease. A significant improvement in her pulmonary function was noted without other therapy directed towards her bronchopulmonary disease.

According to the authors this is the first report of inhalation treatment with dabigatran etexilate in humans, demonstrated by a measurable uptake through the pulmonary tract.

Learning Points:-
• Erroneous inhalation of dabigatran etexilate was associated with measurable dabigatran serum concentrations.

• An improvement in pulmonary function was noticed following long-term inhalative treatment with dabigatran.

• The correct administration technique of medications should be ensured, in particular in elderly patients.

A 87-year-old patient with a medical history of chronic obstructive pulmonary disease (COPD) was admitted with atrial fibrillation of unknown duration in February 2014. Following admission, she was anticoagulated with dabigatran (dabigatran etexilate) 110 mg two times a day and treated with metoprolol 50 mg.

Prior to hospitalisation, the patient was treated with Spiriva (Tiotropium) 18 µg four times a day administrated by Handihaler and Onbrez (indacaterol maleate) four times a day administrated by a Onbreez Breezhaler.

Both medications were prescribed by her family physician due to suspected COPD. Transthoracic echocardiography on admission revealed preserved systolic function with signs of diastolic dysfunction. Due to radiographic signs of pulmonary congestion, she was also treated with an ACE inhibitor and a loop diuretic. The patient was discharged after 2 days of hospitalisation.

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