Stimulation of the Cervical Sympathetic Ganglion for Treatment of Asthma

Asthma is a chronic inflammatory disorder of the airways characterized by shortness of
breath, wheezing, cough, and fatigue. Some people suffer from sudden worsening of asthma
symptoms despite being treated with medications. When people have asthma attacks the muscle
tissue in the airway contracts causing the airway to narrow and decreasing the ability for
the person to breathe.

Neurological pacemakers are FDA approved devices that stimulate nerves in the body and have
been used for the treatment of many disorders such as Parkinson's, epilepsy, chronic pain
and urinary incontinence. Recent animal studies have shown that stimulating (activating a
nerve) the carotid sheath area (located in the neck) can cause the rapid relaxation of the
muscles which contract during an asthma attack. This approach has also been successfully
used in patients at an emergency room when they came in with a severe asthma attack.

Inclusion Criteria:

1. All patients aged 18-70 years of age suffering from mild-to-moderate asthma who have
either:

1. bronchial hyper-responsiveness to MCT

2. bronchial hyper-responsiveness to EVH testing

2. All patients with documented evidence of a positive MCT or EVH test within 36 months
of Visit 1

3. Are capable of reading and understanding questionnaires and providing written
informed consent.

4. Are willing and able to adhere to the study visit schedule and other
protocol-specified procedures.

Exclusion Criteria:

1. Non-English speaking.

2. Subjects experiencing an exacerbation of asthma within 6 weeks of Visit 1

3. Subjects with a forced expiratory volume (FEV1) ≤ 60% predicted, on spirometry

4. Subjects and medications:

1. Subjects allergic to methacholine or any other parasympathomimetic agent

2. Subjects on investigational drugs or participating in interventional research
trial(s), 30 days prior to enrollment or during the duration of the study

3. Subjects currently on β-adrenergic blockers or, a cholinesterase inhibitor

4. Prior to the administering of the MCT/ EVH test:

i) use of a short-acting bronchodilator (within 6hrs.) ii) use of a long-acting
bronchodilator (within 36hrs.) iii) use of inhaled corticosteroids/ leukotriene
modifiers (within 72hrs.) iv) exercise (within 4hrs.)

5. Subject smoking: in the last 6 months or a smoking history of >10 pack-years

6. Subjects who have experienced a febrile illness within 3 weeks of Visit 1

7. Subjects with a history of active poorly controlled epilepsy, cardiovascular disease
(esp. with bradycardia), vagotonia, peptic ulcer disease, thyroid disease, or urinary
tract obstruction or other chronic ailments that would interfere with the current
study

8. Subjects who are pregnant or refuse medically acceptable contraception during the
study period

9. Subjects with a history of >3 stellate ganglion block procedures

10. Subjects who have undergone surgical procedures involving the cervical spine

11. Evidence of coagulopathy with abnormal INR, PT/ PTT and platelet count

12. Subjects allergic to lidocaine (Subject may still participate in the study if they
agree to the procedure without using the Lidoderm patch)

13. Subjects participating in another interventional research trial

14. Subjects with a condition or compliance issue, which in the investigator's opinion
might interfere with participation in the current study

15. Subjects unable or unwilling to provide a written consent to undergo the required
testing/ procedures/ physical exam or answer the questionnaires