• Logo
  • SBMUJournals

The Effect of Low-Dose Ketamine in Treating Acute Asthma Attack; a Randomized Clinical Trial

Mehrdad Esmailian, Mahboubeh Koushkian Esfahani, Farhad Heydari




Introduction: Efficient treatment of asthma can play an important role in controlling asthma attacks, rapid recovery and decrease of patient mortality. Therefore, in the present study the therapeutic effect of low-dose ketamine is evaluated in patients with acute asthma attack.

Methods: In the present single-blind, randomized clinical trial with placebo control, the effect of low-dose intravenous ketamine in treating 18 to 85 year-old asthmatic patients who presented to the emergency department was evaluated. Peak expiratory flow rate (PEFR) and the patients’ response to treatment were measured before and 1 hour after treatment. Additionally, using SPSS 22.0, effectiveness of ketamine with 0.3, 0.4, and 0.5 mg/kg doses followed by infusion of the same dose during 30 minutes were compared with placebo.

Results: 92 patients were enrolled (59.8% female, mean age 48.5 ± 13.9 years). 15 (16.3%) patients were treated with 0.3 mg/kg ketamine, 14 (15.2%) with 0.4 mg/kg, and 16 (17.4%) with 0.5 mg/kg doses. Mean PEFR was 336.2 ± 101.5 liters in the placebo group and 345.8 ± 84.7 liters in the ketamine group before intervention (p = 0.6), while after intervention, they were 352.1 ± 101.2 and 415.8 ± 76.2 liters, respectively (p = 0.001). Ketamine treatment with 0.4 and 0.5 mg/kg doses led to a higher increase in PEFR compared to 0.3mg/kg dose (df: 3, 88; F = 23.8; p < 0.001).

Conclusion: It seems that administration of 0.4 - 0.5 mg/kg doses of intravenous ketamine followed by infusion of the same dose during 30 minutes can be effective for rapid recovery of PEFR in patients with mild to moderate asthma.


Ketamine; asthma; efficiency; peak expiratory flow rate; emergency service, hospital


Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-78.

Heidarnia MA, Entezari A, Moein M, Mehrabi Y, Pourpak Z. Prevalence of asthma symptom in Iran: a meta-analysis. Pejouhesh. 2007;31(3):217-25.

Fazlollahi M, Moein M. National guidelines for asthma. Tehran, Iran: Ministry of Health and Medical Education, Deputy of Health. Center for Non-Communicable Diseases Control, National Committee of Asthema. 2009.

L'Hommedieu CS, Arens J. The use of ketamine for the emergency intubation of patients with status asthmaticus. Annals of emergency medicine. 1987;16(5):568-71.

Cromhout A. Ketamine: its use in the emergency department. Emergency Medicine. 2003;15(2):155-9.

Wai A. Roberts and Hedges: Clinical Procedures in Emergency Medicine. LWW; 2010.

Denmark TK, Crane HA, Brown L. Ketamine to avoid mechanical ventilation in severe pediatric asthma. The Journal of emergency medicine. 2006;30(2):163-6.

Adams N, Jones P. The dose–response characteristics of inhaled corticosteroids when used to treat asthma: an overview of Cochrane systematic reviews. Respiratory medicine. 2006;100(8):1297-306.

Dahl R, Engelstätter R, Trębas-Pietraś E, Kuna P. A 24-week comparison of low-dose ciclesonide and fluticasone propionate in mild to moderate asthma. Respiratory medicine. 2010;104(8):1121-30.

Buston KM, Wood SF. Non-compliance amongst adolescents with asthma: listening to what they tell us about self-management. Family Practice. 2000;17(2):134-8.

Lasserson TJ, Cates CJ, Lasserson EH, White J. Fluticasone versus' extrafine'HFA‐beclomethasone dipropionate for chronic asthma in adults and children. The Cochrane Library. 2006.

BETTS EK, PARKIN CE. Use of ketamine in an asthmatic child: a case report. Anesthesia & Analgesia. 1971;50(3):420-1.

CORSSEN G, GUTIERREZ J, REVES JG, HUBER JR FC. Ketamine in the anesthetic management of asthmatic patients. Anesthesia & Analgesia. 1972;51(4):588-94.

NETTLES DC, HERRIN TJ, MULLEN JG. Ketamine induction in poor-risk patients. Anesthesia & Analgesia. 1973;52(1):59-64.

Rees DI, Howell ML. Ketamine-atracurium by continuous infusion as the sole anesthetic for pulmonary surgery. Anesthesia & Analgesia. 1986;65(8):860-4.

Lau TT, Zed PJ. Does ketamine have a role in managing severe exacerbation of asthma in adults? Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2001;21(9):1100-6.

Petrillo T, Petrillo TM, Fortenberry JD, Linzer JF, Simon HK. Emergency Department Use of Ketamine in Pediatric Status Asthmaticus*. Journal of Asthma. 2001;38(8):657-64.

Strube P, Hallam P. Ketamine by continuous infusion in status asthmaticus. Anaesthesia. 1986;41(10):1017-9.

Huber Jr F, Gutierrez J, Corssen G. Ketamine: its effect on airway resistance in man. Southern medical journal. 1972;65(10):1176-80.

Howton JC, Rose J, Duffy S, Zoltanski T, Levitt MA. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Annals of emergency medicine. 1996;27(2):170-5.

DOI: https://doi.org/10.22037/emergency.v6i1.20997


  • There are currently no refbacks.