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Journal of the New Zealand Medical Association, 06-May-2005, Vol 118 No 1214

Salamol asthma inhaler fails roadside alcohol breath testing

Shane Reti

A failed roadside alcohol breath test to the Salamol asthma inhaler is presented.

Case report

In early April 2005, a 62-year-old non-alcohol-drinking Maori woman was assessed by a New Zealand Police roadside breath-testing (RBT) unit. A few minutes prior to testing, she had taken one puff of her Salamol inhaler. She was instructed to speak into a roadside breath testing device (RBTD), and was immediately informed that she had failed. She explained that she had just used her inhaler and was allowed to proceed on her journey. She then presented to her GP concerned that she had failed a breath test.

Discussion

In early 2005, PHARMAC advised that Ventolin would be replaced by Salamol (Figure 1) as a subsidised metered-dose asthma inhaler (MDI). Salbutamol is the active ingredient in both inhalers, however Salamol also contains ethanol (an alcohol) as a co-solvent whereas Ventolin does not. There are, to date, no reports of failed RBT to MDIs under New Zealand evidential breath-testing conditions.

Figure 1. Salamol asthma inhaler

A review of the overseas literature details positive alcohol breath tests to various MDIs containing ethanol as a co-solvent.1,2 Airomir, a MDI similar to Salamol (and containing salbutamol and ethanol), is reported as showing immediate post-inhalation breath-alcohol levels up to 350 ug/L.3 The active bronchodilator in some non-alcohol-containing MDIs has also been reported as giving elevated breath-alcohol recordings.4

With the assistance of Inspector Rob Lindsay (Road Policing Manager, Northland Police District Headquarters), and under the technical direction of Constable Kerry Neil, the author undertook further testing at the Whangarei Central Police Station in early April, 2005. The author is a 41-year-old Maori male weighing 85 kg, who is non-asthmatic and a lifelong non-alcohol drinker.

The first stage of roadside breath testing (RBT) in New Zealand involves speaking into the RBTD (Alotech AR1005). The author firstly established a baseline alcohol free ‘pass’, and then took two puffs of Salamol before speaking into the RBTD. The author recorded a ‘fail’ at the immediate assessment (alcohol was detected), and also a ‘fail’ at 1 and 2 minutes but a ‘pass’ at 3 minutes. This was repeated over a total of three attempts with one ‘pass’ at 2 minutes instead of 3 minutes.

For the second stage of RBT, a baseline ‘pass’ was again established, the two inhalations were repeated, and then the author blew into the Alotech AR1005 (this time through a mouthpiece). The result was an immediate ‘pass’ (no alcohol detected). This was confirmed over three attempts.

The third stage of alcohol breath-testing is a quantitative assessment blowing twice (2.5 minutes apart) into an Ethylometer (679T). A driver ‘fail’ in New Zealand is greater than 400 ug/L. Anecdotal reports suggest testing with a mouth rinsed in wine records approximately 40 ug/L. A negative baseline was established, and two puffs of Salamol inhaled. The results over three trials to the first blow were 1201, 1283, and 1861 ug/L respectively. The results to the second blow (2.5 minutes later) were all zero.

Further testing is required to confirm the significance of these findings, however the preliminary evidence shows that the alcohol in Salamol inhalers may cause failing of certain aspects of RBT under New Zealand evidential breath-testing conditions. Overseas recommendations for post-MDI re-testing range from 2–20 minutes.

Pending further studies, it is suggested that where Salamol has been recently used, RBT protocols wait for a minimum of 3 minutes before assessing ‘spoken’ RBTD testing or proceeding to stage-2 RBTD ‘blow’-activated breath-testing.

Author information: Shane Reti, Medical Practitioner and Researcher, Whangarei

Correspondence: Dr Shane Reti, 15 Rust Ave, Whangarei; email: salamol@selectpost.com

References:

Gomez HF, Moore L, McKinney P, et al. Evaluation of breath ethanol measurements by metered-dose-inhalers. Ann Emerg Med. 1995;25:608–11.
Logan BK, Distefano S, Case GA. Evaluation of the effect of asthma inhalers and nasal decongestant sprays on a breath alcohol test. J Forensic Science. 1998;43:197–9.
Barry PW, O'Callaghan C. New formulation metered dose inhaler increases breath alcohol levels. Resp Med. 1999;93:167–8.
Bosch X. Using asthma inhalers can give false positive results in breath tests. BMJ. 2002;324:756.