From the Guidelines
Nebulized lidocaine 1% is not recommended as a first-line treatment for cough. While lidocaine has local anesthetic properties that can temporarily suppress the cough reflex by numbing sensory nerves in the airways, evidence supporting its routine use for cough is limited and inconsistent, as noted in the Chest guideline and expert panel report 1. First-line treatments for cough typically depend on the underlying cause and include antitussives like dextromethorphan for dry coughs, expectorants like guaifenesin for productive coughs, or treating the underlying condition such as using bronchodilators for asthma or antibiotics for bacterial infections.
Some key points to consider when evaluating the use of nebulized lidocaine for cough include:
- The potential risks associated with its use, including bronchospasm, local irritation, systemic absorption leading to cardiac effects, and suppression of protective cough reflexes which could increase aspiration risk 1.
- The availability of other treatment options, such as opioids, which have more evidence supporting their use in managing cough among patients with lung cancer, albeit of low methodologic quality 1.
- The importance of assessing aspiration risk prior to the use of local anesthetics, such as nebulized lidocaine, for cough management, particularly in frail patients with cancer 1.
It may have a limited role in specific clinical scenarios, such as refractory cough in terminal illness or for cough suppression during certain procedures, but these uses should be supervised by healthcare providers, as suggested by the expert panel report 1. Patients with persistent cough should seek medical evaluation to identify and treat the underlying cause rather than attempting symptomatic treatment with nebulized lidocaine.
In terms of dosage, if nebulized lidocaine is considered, the suggested dose is typically 5 mL of 0.2% tid, although this may vary depending on the clinical scenario and patient response, as outlined in the indicative doses for antitussives, demulcents, and topical anesthetics 1. However, the primary approach should always prioritize treating the underlying cause of the cough and using evidence-based first-line treatments.
From the Research
Efficacy of Lidocaine 1% Nebulized for Cough
- The effectiveness of lidocaine 1% nebulized as a first-line treatment for cough is not strongly supported by the available evidence 2, 3, 4.
- A randomized controlled trial found that lidocaine throat spray, but not nebulized lidocaine, significantly reduced cough frequency in patients with refractory chronic cough 2.
- Another study suggested that nebulized lidocaine may be effective in reducing cough frequency, but the evidence is limited by small sample sizes and inconsistent results 3, 4.
- Some case reports and descriptive studies have reported successful use of nebulized lidocaine in treating refractory cough, but these findings are not conclusive 5, 6.
Safety and Tolerability
- Nebulized lidocaine is generally well-tolerated, with minimal side effects such as dysphonia, oropharyngeal numbness, and bitter taste 2, 3, 4.
- However, reports of initial bronchoconstriction have occurred, and patients should be monitored for potential adverse effects 4.