Chest
Selected ReportsNebulized Lidocaine in the Treatment of Refractory Cough
Section snippets
Case Report
A 52-year-old white man was referred for evaluation of intractable nonproductive cough, which became unremitting after therapy with glyburide and lisinopril was initiated for diabetes mellitus and hypertension. His medical history was otherwise unremarkable. He denied chills, fever, hemoptysis, night sweats, sputum production, or weight change. He has never used tobacco. No environmental exposures were identified. His symptoms failed to improve after cessation of oral hypoglycemics and
Discussion
The cause of our patient's cough is unclear. The cough persisted despite cessation of ACE inhibitors.3 Reflux esophagitis may be contributing to his cough;4 however, no reflux was identified on initial barium swallow and his symptoms have failed to improve on maximal antireflux medications. Other studies failed to show toxic serum levels after nebulization of 4 or 10 percent lidocaine.2,5 Nebulized lidocaine offers several advantages over the traditional treatment of cough. Antihistamines are
Addendum
Since acceptance of this manuscript for publication, two additional patients with refractory cough have been treated successfully with nebulized lidocaine. The first received lidocaine for 2 months to treat a lisinopril-induced cough that persisted after cessation of the drug. The second was treated with lidocaine for 6 weeks to treat paroxysms of coughing, which appeared to be a complication of paretic vocal cords. Neither patient suffered any adverse effects from the lidocaine.
References (5)
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Bronchial hyperreactivity and cough due to angiotensin-converting enzyme inhibitors
Chest
(1989) Asthma and gastroesophageal reflux (editorial)
Chest
(1989)
Cited by (37)
A case report of an 18-year-old receiving nebulized lidocaine for treatment of COVID-19 cough
2023, Heart and LungCitation Excerpt :Both nebulized and intravenous lidocaine have been studied for use as a cough suppressant. One of the first reports of successful use of nebulized lidocaine was in 3 adults with intractable cough refractory to standard therapy.9 A study of 21 adults with intractable cough secondary to asthma or reactive airway disease used 1-4% nebulized lidocaine (10-20 mg) every 4 to 6 hours.
A Randomized Controlled Trial to Assess the Effect of Lidocaine Administered via Throat Spray and Nebulization in Patients with Refractory Chronic Cough
2021, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Indeed, compared with a saline placebo, lidocaine spray administered to the vocal cords and tracheobronchial tree significantly decreased objective cough frequency during this procedure in a randomized controlled trial.10 A number of case reports and case series have reported the off-license use of nebulized lidocaine as an antitussive in various respiratory disorders, including patients with refractory chronic cough (RCC).11-15 Furthermore, a retrospective case series evaluating nebulized lidocaine in RCC revealed that lidocaine improved cough symptom scores and was effective within the first 2 weeks after treatment in responders.15
Pharmacologic therapy for cough
2011, Current Opinion in PharmacologyCitation Excerpt :Nebulised lidocaine is licensed for the treatment of cough in palliative care (UK) and routinely applied topically to reduce coughing during fibre-optic bronchoscopy. Case reports/series of patients with intractable chronic cough treated with nebulised lidocaine, have reported improvements in cough and although the effects might be expected to be transient, some subjects have claimed benefits lasting several days to weeks [16,17]. However, a randomised study of 127 patients with COPD and cough, found no significant differences in cough severity scores between subjects receiving nebulised lidocaine or bronchodilators [18].
Current and future peripherally-acting antitussives
2006, Respiratory Physiology and NeurobiologyNonpain symptom management
2001, Primary Care - Clinics in Office PracticeCitation Excerpt :Another intervention, particularly effective in refractory cough, is nebulized lidocaine. Lidocaine 1%, 2%, or 4% given by nebulizer at a dose of 3 mL up to every 6 hours has been proved effective.1,21,40,52 Dyspnea is defined variably by patients as shortness of breath, feeling smothered, short of wind, unable to breathe, and air hunger.