Chest
Volume 118, Issue 2, August 2000, Pages 509-515
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Bronchoscopy
Combined Lidocaine and Salbutamol Inhalation for Airway Anesthesia Markedly Protects Against Reflex Bronchoconstriction

https://doi.org/10.1378/chest.118.2.509Get rights and content

Background

Lidocaine inhalation, in subjects with bronchial hyperreactivity, attenuates evoked bronchoconstriction but also irritates airways. Whether salbutamol pretreatment can mitigate airway irritation and whether combined treatment offers more protection than treatment with either drug alone is unknown. Therefore, we evaluated the effects of the inhalation of lidocaine, salbutamol, lidocaine and salbutamol combined, and placebo on an inhalational histamine challenge.

Methods

Fifteen patients with mild asthma were selected by a screening procedure (ie, a provocative concentration of a substance[histamine aerosol of < 18 mg/mL] causing a 20% fall in FEV1 [PC20]). On 4 different days after pretreatment with the inhalation of lidocaine (5 mg/kg), inhalation of salbutamol (1.5 mg), combined treatment, or placebo, the histamine challenge was repeated.

Results

The baseline FEV1 after lidocaine inhalation but prior to the histamine challenge decreased by > 5% in 7 of 15 volunteers, with a mean (± SD) decrease from 3.82 ± 0.90 to 3.54 ± 0.86 L (p = 0.0054). The baseline PC20 for histamine was 6.4 ± 4.3 mg/mL. Both lidocaine and salbutamol inhalation significantly increased PC20 more than twofold (14.9 ± 13.7 and 16.8 ± 10.9 mg/mL, respectively; p = 0,0007) at a lidocaine plasma concentration of 0.7 ± 0.3 μg/mL. Combined treatment quadrupled the PC20 to 29.7 ± 20.3 mg/mL (vs lidocaine, p = 0.002; vs salbutamol, p = 0.003).

Conclusions

Thus, histamine-evoked bronchoconstriction, as a model of reflex bronchoconstriction, can be significantly attenuated by salbutamol or lidocaine inhalation. However, lidocaine inhalation causes significant initial bronchoconstriction. The combined inhalation of salbutamol and lidocaine prevents the initial bronchoconstriction observed with lidocaine alone and offers even more protection to a histamine challenge than either lidocaine or salbutamol alone. Therefore, the combined inhalation of lidocaine and salbutamol can be recommended to mitigate bronchoconstriction when airway instrumentation is required.

Section snippets

Subjects

After approval of the local ethics committee and receiving informed written consent from the patients, 15 subjects ([mean ± SD] age 34.9 ± 6.4 years) were enrolled in this randomized, double-blinded, placebo-controlled study, which is the third part of an extended work consisting of three study arms. The results of the first study arm (IV lidocaine vs salbutamol) and the second study arm (lidocaine inhalation vs IV lidocaine) have already been published.514 The subjects were of normal height

Results

Lidocaine inhalation decreased FEV1 and VC significantly, while both salbutamol and combined salbutamol and lidocaine inhalation improved lung function.

The inhalation of saline solution (placebo) did not alter either FEV1 (3.78 ± 0.92 L; p = 0.6701) or VC (4.88 ± 1.31 L; p = 0.1118). Lidocaine inhalation significantly decreased FEV1 by 7.1% from 3.82 ± 0.90 to 3.54 ± 0.86 L (p = 0.0054), but not VC (4.84 ± 1.12 to 4.70 ± 1.07 L [2.9%]; p = 0.3109). Salbutamol inhalation significantly improved

Discussion

Lidocaine inhalation significantly attenuated bronchial hyperreactivity as much as the inhalation of salbutamol in awake humans. Salbutamol and lidocaine combined attenuated bronchial hyperreactivity even further. Furthermore, lidocaine inhalation evoked a significant initial decrease of FEV1, which was completely prevented by salbutamol pretreatment. Salbutamol pretreatment had no influence on lidocaine absorption and the resulting plasma concentrations.

These results emerged in 15 volunteers

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