Lidocaine in AsthmaMurtaza Rashid M.D

Department of Emergency MedicineRoyal Commission Hospital

Jubail

Lidocaine in AsthmaA short communication

Global Asthma Report 2014

334 million people suffer from Asthma.

14% of the world’s children experience asthma symptoms.

8.6% of young adults (aged 18-45) experience asthma symptoms.

Lidocaine Pharmacology

1) Blocks high speed Voltage gated Sodium (Na) channels in neurons and myocytes during action potential.

Local Anesthetic Cardiac Arrhythmias

Lidocaine Pharmacology

Lidocaine Pharmacology2) Immunomodulatory effects on inflammatory

cells viz. neutrophils, mast cells, macrophages, t cells and eosinophils.

Can Lidocaine be used as an adjunct in

Asthma ?

LidocaineA Novel therapy for a Chronic

Disease

What Literature says:J Immunol. 1998 Apr 15;160(8):4010-7.

Lidocaine and its analogues inhibit IL-5-mediated survival and activation of human eosinophils. Also inhibits CSF for granulocyte and macrophages

LiteratureMayo Clin Proc.1996 Apr;71(4):361-8.

Effect of nebulized lidocaine on severe glucocorticoid-dependent asthma.

Among 20 patients, thirteen were able to discontinue corticosteroids completely despite prolonged use and four has substantial reduction in doses and three had no effect.

LiteratureAnn Allergy Asthma Immunol. 1999;82:29-32. Effect of Nebulised Lidocaine in the treatment of

severe asthma in children: a pilot study

A pilot study involving six pediatric patients with severe asthma added support to the interpretation that nebulized lidocaine in doses of 40 to 100 mg (0.8 to 2.5 mg/kg/ dose) four times daily had indeed steroid sparing actions

LITERATURE SAYSJ Allergy Clin Immunol.2004 May;113(5):853-9.Treatment of asthma with nebulized lidocaine: a randomized, placebo-

controlled study.

50 subjects, with 25 used lidocaine and 25 used saline to withdraw steroids

Indicators of asthma severity showed benefit for the lidocaine-treated group: changes in FEV(1) (P < or =.001), nighttime awakenings (P < or =.02), symptoms (P < or =.010), bronchodilator use (P < or =.010), and blood eosinophil counts (P < or =.020)

LiteratureJOURNAL OF CASE REPORTS 2015;5(1):42-44 Lidocaine Nebulization in the Treatment of Acute Severe

Refractory Bronchial Asthma.70 yr old male status asthmaticus

refractory to bronchodilators, hydrocortisone, intravenous magnesium was given 2mg/kg of nebulised Lidocaine q4h dramatically improved the conditions.

Thank you