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Journal of veterinary internal medicine2026; 40(1); aalaf053; doi: 10.1093/jvimsj/aalaf053

An in-hospital clinical trial assessing nebulized lidocaine compared to saline for treatment of asthma in horses.

Abstract: Corticosteroids are the main pharmacologic treatment for equine asthma (EA) but may have adverse effects in metabolically unstable horses. Recent pilot studies support the use of nebulized lidocaine as an alternative treatment option. Objective: Nebulized lidocaine will improve EA-associated clinical variables and airway inflammation. Methods: Twenty client-owned horses diagnosed with EA. Methods: Randomized, blinded, in-hospital study comparing 1 mg/kg preservative-free 4% lidocaine (n = 10) nebulized via Flexineb (twice daily for 7 doses) to 0.9% saline control (n = 10). Clinical examination, endoscopy, lung function, bronchoalveolar lavage (BAL) cytology, and inflammatory cytokines in blood and epithelial lining fluid (ELF) were compared between treatment groups using univariate analyses. Global linear models were used to assess covariate impact (P < .05). Results: The effect of treatment on clinical variables (clinical score, lung function, mucus, and BAL cytology) did not differ between saline and lidocaine treated horses. However, the severity of EA as a covariate significantly impacted multiple baseline variables and confounded the effect of treatment type. Saline-treated horses showed significantly larger decreases in ELF tissue necrosis factor alpha (P = .04) and interferon gamma concentrations (P = .03), compared with lidocaine-treated horses, independent of covariates. Conclusions: We did not identify a difference in treatment effect of nebulized lidocaine compared to saline on clinical variables in hospitalized asthmatic horses. A longer duration of lidocaine administration or focus on severe EA may be necessary to establish treatment effects. Observed changes in lower airway cytokine concentrations suggest that saline may have more than a placebo effect in treating EA.
© The Author(s) 2026. Published by Oxford University Press on behalf of the American College of Veterinary Internal Medicine.
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Publication Date: 2026-02-26 PubMed ID: 41742534PubMed Central: PMC12881962DOI: 10.1093/jvimsj/aalaf053Google Scholar: Lookup
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  • Journal Article
  • Randomized Controlled Trial
  • Veterinary
  • Clinical Trial
  • Veterinary

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This clinical trial evaluated the effectiveness of nebulized lidocaine compared to saline for treating asthma in horses, focusing on clinical signs and airway inflammation.
  • The study found no significant clinical improvement with lidocaine versus saline but observed inflammatory changes suggesting saline may have an active effect.

Background

  • Equine asthma (EA) is commonly treated with corticosteroids, which can cause side effects in horses with metabolic issues.
  • Nebulized lidocaine has emerged from pilot studies as a potential alternative treatment to reduce airway inflammation without using steroids.
  • The researchers sought to test whether nebulized lidocaine could improve clinical signs and airway inflammation in horses with EA.

Study Design and Methods

  • Twenty client-owned horses diagnosed with EA participated in an in-hospital, randomized, blinded clinical trial.
  • Horses were split into two groups: one group (n = 10) received nebulized preservative-free 4% lidocaine at 1 mg/kg twice daily (7 doses total), and the other group (n = 10) received nebulized 0.9% saline as a control.
  • Treatments were administered via a Flexineb nebulizer device.
  • Outcome measures included:
    • Clinical examination and scoring of respiratory signs.
    • Endoscopy to evaluate airway mucus and inflammation.
    • Lung function testing.
    • Bronchoalveolar lavage (BAL) cytology to measure immune cell types in the airway.
    • Measurement of inflammatory cytokines such as tissue necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) in blood and epithelial lining fluid (ELF).
  • Data were analyzed using univariate analyses for group comparisons and global linear models to adjust for covariates such as EA severity, with significance set at P < 0.05.

Results

  • No significant differences were found between lidocaine and saline groups in primary clinical variables, including clinical score, lung function, airway mucus, and BAL cytology.
  • The severity of EA at baseline significantly influenced many clinical variables and confounded treatment effect assessments.
  • Compared to lidocaine, horses treated with saline showed significantly larger decreases in inflammatory cytokines measured in the ELF:
    • Tissue necrosis factor alpha (TNF-α) concentration decreased more in the saline group (P = 0.04).
    • Interferon gamma (IFN-γ) concentration decreased more in the saline group (P = 0.03).
  • These cytokine changes were independent of other covariates, indicating a possible intrinsic effect of saline treatment.

Conclusions and Implications

  • The study did not find evidence that nebulized lidocaine improved clinical outcomes compared to saline in hospitalized horses with asthma over a 7-dose treatment period.
  • A longer treatment duration or targeting horses with more severe asthma might be necessary to detect significant effects of lidocaine.
  • The finding that saline reduced certain airway inflammatory cytokines challenges the assumption that saline is an inert placebo in this context, suggesting it may have therapeutic properties.
  • This research highlights the complexity of treating equine asthma and the need for further trials to explore alternative therapies and optimize treatment protocols.

Cite This Article

APA
Mahalingam-Dhingra A, Bedenice D, South A, Minuto J, Robins TJ, Trautwein V, Larkin M, Wagner B, Mazan MR. (2026). An in-hospital clinical trial assessing nebulized lidocaine compared to saline for treatment of asthma in horses. J Vet Intern Med, 40(1), aalaf053. https://doi.org/10.1093/jvimsj/aalaf053

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 40
Issue: 1
PII: aalaf053

Researcher Affiliations

Mahalingam-Dhingra, Ananya
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Bedenice, Daniela
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
South, Adam
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Minuto, Jillian
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Robins, Tyler-Jane
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Trautwein, Victoria
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Larkin, Melissa
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.
Wagner, Bettina
  • Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.
Mazan, Melissa R
  • Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536, United States.

MeSH Terms

  • Animals
  • Lidocaine / administration & dosage
  • Lidocaine / therapeutic use
  • Horses
  • Horse Diseases / drug therapy
  • Asthma / veterinary
  • Asthma / drug therapy
  • Female
  • Nebulizers and Vaporizers / veterinary
  • Male
  • Saline Solution / administration & dosage
  • Saline Solution / therapeutic use
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / therapeutic use
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoalveolar Lavage Fluid / chemistry
  • Cytokines / blood
  • Administration, Inhalation

Grant Funding

  • Grayson-Jockey Club Research Foundation

Conflict of Interest Statement

The authors declare no conflicts of interest.

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