Unveiling the Unforeseen: Diclofenac-Triggered Near-Fatal Rapid Onset Asthma in a Stable Asthmatic Managed by Noninvasive Ventilation: A Case Report

Diclofenac tablets are commonly used in Sri Lanka and rapid onset asthma triggered by them is a rare phenomenon. The use of noninvasive ventilation in status asthmaticus is still under consideration in the guidelines. We discuss a case of rapid onset acute asthma managed with noninvasive ventilation successfully. This report details a 35-year-old woman with a history of mild intermittent asthma, who presented with rapid-onset worsening severe respiratory distress shortly after ingesting oral diclofenac sodium tablets for mechanical neck pain. Despite being well-controlled with inhalers for over a year, she developed near-fatal asthma, characterised by severe hypoxia, hypercapnia with altered mental status, requiring immediate, intervention. The patient was treated with high-flow oxygen, back-to-back nebulisations, and non-invasive ventilation (bi-level positive airway pressure mode), resulting in clinical improvement. Here, we highlight the rare but severe risk of diclofenac-induced asthma exacerbations and signify the importance of prompt recognition, aggressive treatment in managing life-threatening asthmatic episodes along with consideration of noninvasive ventilation in management of acute asthmatic attacks. Clinicians should be aware about the rapid onset acute asthma which resolves completely with proper management.