Nebulized Lidocaine Inhalation In The Treatment Of Patients With Acute Asthma

[paymanz]

Nebulized lidocaine inhalation in the treatment of patients with acute asthma

World J Emerg Med. 2011; 2(1): 30–32.

PMCID: PMC4129744
Nebulized lidocaine inhalation in the treatment of patients with acute asthma
Zu-ming Lv, Li Chen, and Jie Tang
Author information ► Article notes ► Copyright and License information ►

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Abstract
BACKGROUND:
Lidocaine can promote the apoptosis of eosinophils, which is normally delayed by IL-5; it has a good effect on serious steroid resistant asthma (SRA). The study aimed to explore the effect of nebulized lidocaine inhalation on asthma.

METHODS:
It was a randomized, double-blind, placebo-controlled and prospective study. A total of 36 patients with acute asthma were divided into groups A1, A2, B1 and B2, with 9 patients in each group. The patients of groups A1 and A2 had steroid resistant asthma (SRA) and those of groups B1 and B2 had steroid sensitive asthma (SSA). Patients in groups A2 and B1 were administered nebulized lidocaine in addition to routine treatment, while patients in groups A1 and B2 were given nebulized normal saline apart from routine treatment and served as placebo-controlled groups.

RESULTS:
There were significant differences in heart rate, respiratory rate, and peak flow rate and forced expiratory volume in one second between the experimental groups and the placebo-controlled groups. There was no significant difference between groups A2 and B1, and between A1 and B2.

CONCLUSION:

 

[cjm]

Nebulized lidocaine inhalation in the treatment of patients with acute asthma

World J Emerg Med. 2011; 2(1): 30–32.

PMCID: PMC4129744
Nebulized lidocaine inhalation in the treatment of patients with acute asthma
Zu-ming Lv, Li Chen, and Jie Tang
Author information ► Article notes ► Copyright and License information ►

Go to:
Abstract
BACKGROUND:
Lidocaine can promote the apoptosis of eosinophils, which is normally delayed by IL-5; it has a good effect on serious steroid resistant asthma (SRA). The study aimed to explore the effect of nebulized lidocaine inhalation on asthma.

METHODS:
It was a randomized, double-blind, placebo-controlled and prospective study. A total of 36 patients with acute asthma were divided into groups A1, A2, B1 and B2, with 9 patients in each group. The patients of groups A1 and A2 had steroid resistant asthma (SRA) and those of groups B1 and B2 had steroid sensitive asthma (SSA). Patients in groups A2 and B1 were administered nebulized lidocaine in addition to routine treatment, while patients in groups A1 and B2 were given nebulized normal saline apart from routine treatment and served as placebo-controlled groups.

RESULTS:
There were significant differences in heart rate, respiratory rate, and peak flow rate and forced expiratory volume in one second between the experimental groups and the placebo-controlled groups. There was no significant difference between groups A2 and B1, and between A1 and B2.

CONCLUSION:

It took me a minute but I finally groked what the authors meant by "no significant difference", because it's confusing to see the saline control group end up with 7% higher FEV¹ and PEF* than the lidocaine-treated group (see red lines), but the saline group were big baddies to begin with, blowing houses down before anyone got drugged (see yellow lines).
*"FEV¹ and PEF are the most important variables among all parameters because they objectively reflect the degree of airway stenosis." TL;DR**: FEV long blow, PEF hard blow.

In short, lido no better than saline at asthma relief.

Two observations:

1 )This study was too dang small -- "the result may be due to the limited number of patients in each group." Lidocaine in surprisingly small oral doses eases my breathing and relaxes my chest/diaphragm. The effects for me have been linear up to 500 mg per diem, increasingly penetrating and easing. I had a neat portable nebulizer for a while and put everything in it and I might replicate the study if I still had it, but the point I'm trying to make is oral is good enough for asthma and the side effects are non-existent at the dosages I feel my breathing respond.

2) Saline has an understated effect on airway function. A higher dose of lidocaine than the one used (2%, 5mL = 100 mg) would have been safe and indicated.

The gem from the chart, indicated in blue is 8% lower heart rate and 5% lower respiration rate after nebulized lidocaine.

**TL;DR stands for too long didn't research 'cause my butt thought FEV or forced expiration volume was the hard blow, and youse can just read the tiny little study for what the acronyms stand fer :)

 

[cjm]

"The safety of lidocaine in bronchoscopy is well established. Such usage leads generally to low blood concentrations of the drug on which its toxicity depends. The doses used in our patients give the equivalent of 10 to 20 mg lidocaine every 4 to 6 hours or 40 to 120 mg per day, which are well below the average 200 to 400 mg total dose for short procedures recommended by the manufacturer for topical use, and the initial 100 mg intravenous bolus, followed by continuous infusion at 2 to 4 mg/min for several days used in cardiology. Larger individual doses of 230 to 364 mg and even up to 572 mg and over have been studied under controlled conditions and found to be quite safe. In these 3 well-conducted studies, only 5% of patients achieved blood lidocaine concentrations in the minor toxicity range after bronchoscopy with these unusually large doses. None suffered any adverse effects. The low blood concentrations achieved through inhalation are unlikely to contribute to the prophylaxis of cardiac arrhythmias."

Sci-Hub | Lidocaine inhalation for cough suppression. The American Journal of Emergency Medicine, 19(3), 206–207 | 10.1053/ajem.2001.21724