Effect of nebulized lidocaine on severe glucocorticoid-dependent asthma

To determine whether nebulized lidocaine is a useful therapy in patients with severe glucocorticoid-dependent asthma.

We prospectively conducted an open study of the effects of administration of nebulized lidocaine four times daily in 20 patients with asthma who had side effects of exogenous hypercortisolism.

The 18 women and 2 men, who were 19 to 71 years of age, all had severe asthma that necessitated both topical and systemic administration of glucocorticoids to control symptoms of airflow obstruction. Treatment consisted of nebulized lidocaine, 40 to 160 mg four times daily. Initially, all topical and systemic glucocorticoid regimens were maintained; if peak flow rates remained stable and symptoms of asthma were well controlled, orally administered glucocorticoid regimens were slowly reduced.

Thirteen patients were able to discontinue oral use of glucocorticoids entirely, despite prolonged glucocorticoid dependence (mean 6.6 years and median 3 years for the 20 patients); 4 achieved reduction in their daily glucocorticoid requirement while maintaining control of symptoms of asthma (duration of glucocorticoid dependence for responders, mean 6.2 years and median 3.2 years). Three patients had no apparent response, as determined by their continued severe asthma symptoms and inability to reduce oral glucocorticoid requirements.

These results suggest that nebulized lidocaine is a useful therapy for chronic asthma, allowing reduction or elimination of oral glucocorticoid therapy.