Treatment for Coughing After Inhaling Chlorhexidine and Lysol While Cleaning
Immediately remove the patient from the exposure source, ensure fresh air, and administer a short-acting inhaled bronchodilator (such as albuterol) along with inhaled ipratropium bromide to reduce airway irritation and cough. 1, 2
Immediate Management
First-Line Interventions
- Remove from exposure immediately and move to fresh air to prevent continued inhalation of irritants 1
- Administer short-acting β-agonist bronchodilators (e.g., albuterol) to control bronchospasm and reduce cough from airway irritation 2
- Add inhaled ipratropium bromide as it has demonstrated reliable effects on cough reduction from inhaled irritants 3, 2
- Consider inhaled corticosteroids started immediately if respiratory irritation is significant, as early treatment can reduce respiratory irritation and prevent progression to toxic pneumonitis 4
The evidence strongly supports that inhaled anticholinergics like ipratropium bromide are particularly effective for cough due to respiratory irritants 1. While the guidelines primarily address chronic bronchitis from workplace hazards and environmental pollutants, the mechanism of action—reducing airway irritation from noxious inhaled agents—directly applies to acute chemical exposure 1.
Symptomatic Cough Suppression
- For bothersome cough interfering with sleep or quality of life, use dextromethorphan (60 mg for maximum effect) as it is FDA-approved for cough due to inhaled irritants 5
- Codeine can be used as an alternative for short-term symptomatic relief, though it has a greater adverse effect profile than dextromethorphan 1, 2
- Avoid expectorants as they have no proven benefit for cough due to irritant exposure 1, 2
Monitoring and Follow-Up
Assessment for Complications
- Monitor oxygen saturation and respiratory status closely for the first 24-48 hours, as Lysol exposure can cause acute respiratory distress syndrome requiring mechanical ventilation 6
- Obtain chest radiography if dyspnea develops to assess for pulmonary infiltrates or toxic pneumonitis 6
- Watch for signs of hypersensitivity reactions to chlorhexidine, including contact dermatitis, bronchospasm, or anaphylaxis, as these can range from mild to life-threatening 7, 8
Escalation of Care
- If respiratory distress develops despite initial bronchodilator therapy, consider high-dose systemic corticosteroids (hydrocortisone 30 mg/kg/day or equivalent) as this has been effective in severe cases of chemical inhalation injury 6
- Admit to intensive care if hypoxemia is refractory to supplemental oxygen or if bilateral pulmonary infiltrates develop 6
Important Caveats
Do not use antibiotics unless there is evidence of secondary bacterial infection, as the initial injury is chemical, not infectious 1, 2. The most critical intervention is immediate cessation of exposure—the ACCP guidelines emphasize that avoidance of respiratory irritants is the cornerstone of therapy, with 90% of patients experiencing resolution after removing the offending agent 2.
Chlorhexidine sensitization can occur, and prior exposure may increase risk of severe allergic reactions including anaphylaxis 7, 8. If the patient develops urticaria, angioedema, or worsening bronchospasm despite bronchodilators, treat as anaphylaxis with epinephrine.