[A case of severe bronchial asthma following first use of timolol ophthalmic solution]

A 65-year-old woman with stable atopic bronchial asthma received a prescription for timolol maleate eye drops (0.25% solution, one drop twice a day to both eyes) for glaucoma. On that evening, ten minutes after administration of the first application of timolol, the patient experienced wheeze and slight difficulty in breathing. Within the next ten minutes, her respiration became obviously asthmatic. Her symptoms progressed rapidly. When she arrived at our hospital, reduced respiratory sounds, cyanosis and disturbance of consciousness were observed. After treatment with aminophylline, hydrocortisone, epinephrine and oxygen inhalation, her symptoms completely recovered. In a provocation test, fifteen minutes after application of timolol, wheeze and dyspnea were induced following an increase in respiratory resistance. After the asthma attack, transient hypoxemia, bradycardia and decrease in blood pressure were also observed.