The Patient’s Asthma Has Flared Up: Prescribe Nebulized Lidocaine
Autor: Marcio Augusto Lacerda | Publicado: 2012-09-04T20:08:00-03:00




Nota do Blog: &nbsp;Resposta para quem nao acredita que ha producao cientifica no Brasil....

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http://page2anesthesiology.org/2012/the-patients-asthma-has-flared-up-prescribe-nebulized-lidocaine/

09/04/2012



tags:&nbsp;asthma,&nbsp;lidocaine


Author: Alan J Schwartz







There is great potential for clinical use of inhaled lidocaine to effectively treat asthma. (Image source: Thinkstock)


Ask any anesthesiology resident about treating asthma and he/she will tell you to prescribe inhaled bronchodilators and steroids. There is also a need for oral steroid rescues at times. Control of asthma has great potential clinical benefit for patients because uncontrolled, this inflammatory process results in mucus production, airway smooth muscle hyperplasia and hypersensitivity with restricted airflow that could be fatal; airway remodeling (subepithelial fibrosis and increased collagen) is a key byproduct of chronic asthma. In the article “Nebulized Lidocaine Prevents Airway Inflammation, Peribronchial Fibrosis, and Mucus Production in a Murine Model of Asthma”&nbsp;published in this month’s issue of&nbsp;Anesthesiology, Dr. Magda F. Serra (Research Assistant), corresponding author Dr. Marco A. Martins (Senior Researcher and Head of Laboratory of Inflammation, Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation [FIOCRUZ], Rio de Janeiro, Brazil) and colleagues suggest the use of inhaled lidocaine as an alternative therapy to attenuate the effects of these potentially devastating airway changes.

As is often the case in medicine,


Serendipitously, while measuring eosinophil-active cytokines in bronchoalveolar lavage (BAL) effluent from asthmatic patients…lidocaine (used for topical anesthesia during the BAL procedure) [was identified] as a potent inhibitor of cytokine-evoked survival and activation of eosinophils. The observation that lidocaine, in addition to preventing bronchospasm, could mimic the antieosinophil properties of glucocorticoids strongly stimulated investigations on the putative application of lidocaine in asthma therapy.


Using a murine model, Serra and colleagues investigated the use of lidocaine to mitigate the adverse effects of chronic asthma hinted at during clinical BAL studies.

They demonstrated the following:


…nebulized lidocaine prevents AHR [airway hyperreactivity], eosinophilic inflammatory infiltrates, mucus secretion, subepithelial fibrosis, collagen deposition in lungs, and matrix metalloproteinase-9 activity triggered by repeated ovalbumin intranasal challenges in ovalbumin-sensitized mice. This effect is associated with decreased levels of proinflammatory Th2 cytokines and eotaxin-1 in parallel with abrogation of GATA-3 expression [… these] findings support the hypothesis that inhaled lidocaine can be efficacious for the treatment of asthma, particularly for the improvement of lung function, tissue remodeling, and mucus hypersecretion.


When asked what causes the signs and symptoms of asthma, a common response implicates eosinophils. Lidocaine is clinically beneficial in this regard because it is associated with apoptosis of eosinophils.

Serra et al. have provided a through study of the cellular effects of lidocaine related to clinical benefit for patients, thus enabling anesthesiologists to have a more precise understanding of the basic science behind the clinical benefit. As noted in the conclusion of the article,


these findings reveal that nebulized lidocaine prevents airway eosinophilic inflammation, bronchial hyperreactivity, and pulmonary remodeling by simultaneous depletion of Th2 cytokines such as IL-4, IL-5, and IL-13, as well as eotaxin-1, in a mechanism closely related to the down-regulation of GATA-3 expression. These results reinforce the prospect of further exploiting lidocaine and/or lidocaine analogues for asthma therapy and drug development.