Treatment of asthma with nebulized lidocaine: a randomized, placebo-controlled study.
BACKGROUND
In 2 prior uncontrolled studies, nebulized lidocaine reduced oral glucocorticoid use in patients with severe glucocorticoid-dependent asthma.


OBJECTIVE
We tested the safety and efficacy of nebulized lidocaine in a randomized, placebo-controlled study in patients with mild-to-moderate asthma.


METHODS
We recruited 50 subjects (25 receiving lidocaine and 25 receiving placebo); all had a prebronchodilator FEV(1) of 64% to 125% of predicted normal value and were treated with daily inhaled glucocorticoids (but not systemic glucocorticoids) and bronchodilators for at least 2 months. Before treatment, subjects monitored their symptoms and peak flow values and maintained their medications for 2 weeks. At initiation, subjects inhaled either nebulized placebo (saline) or lidocaine (4%, 100 mg) 4 times daily. All subjects were instructed to reduce their inhaled glucocorticoid dosage by one half each week for 3 weeks and to discontinue glucocorticoid treatment at week 4. The subjects continued the nebulized lidocaine or placebo for a total of 8 weeks, monitored their symptoms, and used bronchodilators to control symptoms.


RESULTS
Indicators of asthma severity showed benefit for the lidocaine-treated group: changes in FEV(1) (P < or =.001), nighttime awakenings (P < or =.02), symptoms (P < or =.010), bronchodilator use (P < or =.010), and blood eosinophil counts (P < or =.020). Subjects in both groups reduced use of inhaled glucocorticoids comparably. Subjects receiving nebulized placebo showed increases in their symptom scores, bronchodilator use (P < or =.05 for both), and blood eosinophil counts (P < or =.01) and decreases in FEV(1) (P < or =.001).


CONCLUSIONS
Nebulized lidocaine provided effective and safe therapy in subjects with mild-to-moderate asthma.
Hunt
Loren W
LW
Department of Internal Medicine, Division of Allergic Diseases, Mayo Clinic and Foundation, Mayo Graduate School of Medicine, Rochester, MN 55905, USA.
Frigas
Evangelo
E
Butterfield
Joseph H
JH
Kita
Hirohito
H
Blomgren
Judith
J
Dunnette
Sandra L
SL
Offord
Kenneth P
KP
Gleich
Gerald J
GJ
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D004804:Eosinophils; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007958:Leukocyte Count; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012449:Safety
D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D008012:Lidocaine