Lidocaine in Acute Asthma

1. Murtaza Rashid M.D
Department of Emergency Medicine
Royal Commission Hospital
Jubail

2. Lidocaine in Asthma
A short communication

3. 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.

4. Lidocaine Pharmacology
1) Blocks high speed Voltage gated Sodium (Na)
channels in neurons and myocytes during action
potential.
Local Anesthetic
Cardiac Arrhythmias

5. Lidocaine Pharmacology

6. Lidocaine Pharmacology
2) Immunomodulatory effects on inflammatory cells viz.
neutrophils, mast cells, macrophages, t cells and
eosinophils.
Can Lidocaine be used as an adjunct in Asthma ?

7. A Novel therapy for a Chronic
Disease

8. 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

9. Literature
 Mayo 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.

10. Literature
 Ann 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

11. LITERATURE SAYS
 J 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)

12. Literature
 JOURNAL 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.

14. Thank you