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 lidocalne 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.