Asthma diagnosis and treatment
Treatment of asthma with nebulized lidocaine: A randomized, placebo-controlled study

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Abstract

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 FEV1 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 FEV1 (P ≤ .001), nighttime awakenings (P ≤ .02), symptoms (P ≤ .010), bronchodilator use (P ≤ .010), and blood eosinophil counts (P ≤ .020). Subjects in both groups reduced use of inhaled glucocorticoids comparably. Subjects receiving nebulized placebo showed increases in their symptom scores, bronchodilator use (P ≤ .05 for both), and blood eosinophil counts (P ≤ .01) and decreases in FEV1 (P ≤ .001).

Conclusion

Nebulized lidocaine provided effective and safe therapy in subjects with mild-to-moderate asthma.

Section snippets

Subject selection

Fifty subjects were recruited from the Rochester, Minnesota, area (18 male and 32 female subjects) who satisfied the inclusion criteria: 18 to 65 years of age, American Thoracic Society criteria for asthma (allergic or nonallergic),13 prebronchodilator FEV1 of 64% to 125% of predicted normal value, and daily treatment with inhaled glucocorticoids (triamcinolone, flunisolide, beclomethasone, or fluticasone) and bronchodilators (β2-agonists, theophylline, or ipratropium) for a minimum of 2

Results

Table I summarizes the subjects' characteristics at the beginning of the study (baseline). The treatment groups had similar median values for age, FEV1 in liters, FEV1 percent predicted, methacholine PD20, daily inhaled glucocorticoid use level in micrograms, nighttime awakenings, and number of blood eosinophils. Symptom scores and bronchodilator use were significantly greater in the lidocaine-treated group. The length of prior inhaled glucocorticoid use was comparable between the groups; the

Discussion

Prior uncontrolled studies of adults10 and children11., 12. with severe asthma requiring systemic glucocorticoids showed that nebulized lidocaine is a safe and effective steroid-sparing treatment. In this randomized, placebo-controlled study, nebulized lidocaine replaced inhaled glucocorticoids in subjects with mild-to-moderate asthma; its effects on pulmonary function, symptom scores, and blood eosinophils were comparable with those of glucocorticoids. This study was double blind, but when

Acknowledgements

We thank C. E. Reed, MD, for assistance in the design of this study and C. Adolphson and L. Arneson for preparation of the manuscript.

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    Supported by grants from the National Institutes of Health, AI 34577, and from the Mayo Foundation.

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