From the Guidelines
Nebulized lidocaine is effective for managing refractory cough in adult patients with lung cancer, particularly when other treatments have failed, as suggested by the 2017 Chest guideline and expert panel report 1. The use of nebulized lidocaine for cough management is recommended as a trial option for patients with opioid-resistant cough that does not respond to peripheral antitussives, according to the 2017 guideline 1. Key points to consider when using nebulized lidocaine for cough management include:
- Starting with a low dose and titrating to effect, as the optimal dose is unknown
- Administering the medication via nebulizer, typically at a concentration of 2%
- Monitoring patients for potential side effects, such as throat numbness, bitter taste, and bronchospasm
- Advising patients to avoid eating or drinking for 30-60 minutes after administration due to the risk of aspiration from reduced gag reflex It's essential to note that nebulized lidocaine should only be used under the guidance of a healthcare professional, as it can have serious side effects if not used properly. The 1997 British Thoracic Society guidelines also mention the use of local anesthetics, such as lignocaine, for the palliation of non-productive cough, particularly if due to large airway tumor, bronchial stent, or diffuse lung disease 1. However, the most recent and highest-quality evidence comes from the 2017 Chest guideline, which provides a more comprehensive approach to cough management in adult patients with lung cancer 1.
From the Research
Efficacy of Nebulized Lidocaine
- Nebulized lidocaine has been shown to be effective in treating intractable cough and asthma in several studies 2, 3, 4.
- A randomized, placebo-controlled study found that nebulized lidocaine reduced symptoms and improved lung function in patients with mild-to-moderate asthma 3.
- Another study found that nebulized lidocaine was effective in suppressing cough in patients with intractable cough 2.
Safety and Side Effects
- Nebulized lidocaine is generally well-tolerated, with minimal side effects including dysphonia, oropharyngeal numbness, and bitter taste 2, 4.
- However, there have been reports of initial bronchoconstriction and anaphylactic shock following lidocaine aerosol inhalation 5, 6.
- Plasma concentrations of lidocaine were found to be far below the toxic threshold in one study 5.
Dosage and Administration
- The optimal dosage of nebulized lidocaine is not established, but studies have used doses ranging from 10 mg to 400 mg 2, 4.
- One study found that a lidocaine dose of 2.0 mg kg-1 as a 4% solution can be recommended for local anesthesia and attenuation of bronchial hyper-reactivity with the least airway irritation 5.