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Journal of Case Reports
Lidocaine Nebulization in the Treatment of Acute Severe Refractory Bronchial Asthma

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Talib Khan1, Shaqul Qamar Wani2, Zulfiqar Ali1, Murtaza Asif Ali1, Syed Amer Zahoor1, Imtyaz Naqash1, Bashir Ahmad Dar1
From the Departments of 1Anesthesiology and Critical care and 2Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, 190011, India.
Corresponding Author:
Dr. Talib Khan 
Email: drtalibkhan@hotmail.com
Received: 04-NOV-2014 Accepted: 10-JAN-2015 Published Online: 30-JAN-2015
DOI: http://dx.doi.org/10.17659/01.2015.0012
Abstract
Status asthmaticus is an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary from a mild form to a severe form with bronchospasm, airway inflammation, and mucus plugging that can cause difficulty in breathing, carbon dioxide retention, hypoxemia, and respiratory failure. Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to a potent allergen or irritant, or after exercise in a cold environment. Lidocaine is a local anaesthetic that blocks voltage gated sodium channels in neurons and cardiac cells, and is used as a short acting local anaesthetic and anti-arrhythmic agent. Interestingly lidocaine also inhibits the function of non-excitable cells, particularly inflammatory cells, such as neutrophils, eosinophils, macrophages, mast cells and TH2 cells, raising the promising possibility of its alternative clinical applications in the control of chronic inflammatory diseases, including asthma. We report a case of a 70 year old Asian male patient, suffering from bronchial asthma, admitted with acute exacerbation with fever, impaired consciousness, loose motions and vomiting. The patient had developed herpes zoster ophthalmicus one week back. During the course of hospital stay, the patient developed status asthmaticus not responding to the conventional management, and was managed with nebulised 2% lidocaine resulting in a considerable improvement in signs and symptoms. In addition, the patient also got relief from the pain of herpes zoster ophthalmicus. 
Keywords : Lidocaine, Bronchial Spasm, Herpes Zoster Ophthalmicus, Pain, Anesthesia, Humans.
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