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Combined Lidocaine and Salbutamol Inhalation for Airway Anesthesia Markedly Protects Against Reflex Bronchoconstriction^*

^* From the Abteilung für Anästhesiologie und Intensivmedizin (Drs. Groeben, Silvanus, and Peters) and Abteilung für Gastroenterologie (Ms. Beste), Universität Essen, Essen, Germany.

Correspondence to: Harald Groeben, MD, Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Hufelandstr 55, 45122 Essen, Germany; e-mail: harald.groeben{at}uni-essen.de

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.

Key Words: airway resistance • asthma • bronchospasm • lidocaine • lung

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