Chest
Volume 105, Issue 5, May 1994, Pages 1592-1593
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Selected Reports
Nebulized Lidocaine in the Treatment of Refractory Cough

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A 52-year-old man with intractable cough refractory to standard therapy was treated successfully with chronic nebulized lidocaine. He has experienced no adverse effects from the lidocaine except for occasional mild dysphonia. Measured serum levels of lidocaine after treatment have never exceeded 4.0 mg/dl. This case shows prolonged therapy with nebulized lidocaine is a safe and effective treatment for 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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