A 52-year-old man with intractable cough refractory to standard therapy was treated favorably with chronic nebulized lidocaine.

A 52-year-old man with intractable cough refractory to standard therapy was treated favorably with chronic nebulized lidocaine. He has experienced no adverse powers from the lidocaine except for occasional mild dysphonia. Measured serum flushs of lidocaine after treatment have none exceeded 4.0 mg/dl. This case indicates prolonged therapy with nebulized lidocaine is a safe and effective treatment for refractory cough

Intractable cough is an infrequent but potentially disabling illness. Antihistamines, benzodiazipines, narcotics, and phenothiazines have been reported to palliate coughing.[1] Nebulized lidocaine is used routinely as an antitussive before bronchoscopy[2] The following case quick in emergenciess a patient with intractable cough that has been treated prosperously with nebulized lidocaine.

CASE REPORT

A 52-year-old white man was referr 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, heat hemoptysis, night sweats, sputum production, or weight change. He has none used tobacco. No environmental aspects were identified. His symptoms failed to improve after cessation of oral hypoglycemics and angiotensin coverting enzyme inhibitors. He ferocious off a roof during a paroxysm of coughing, fracturing his wrist and shoulder.

forward presentation, he was unable to speak in completed sentences due to coughing. Vital signs, ears, nares, oropharynx, and lymph node overlook were normal. His lung were clear to auscultation and percussion; inspiratory to expiratory ratio was normal. The interval of his examination was unremarkable. Laboratory evaluation revealed moderate hyperglycemia. Chest roentgenograms and comput tomograms of the chest and sinuses were normal. Methacholine challenge, pulmonary function testing, and tuberculin skin testing were normal. Rhinolaryngoscopy and bronchoalveolar lavage (with cultures) gave negative deductions on two occasions. Barium swallow showed mild antritis; no ebb was revealed despite coughing during the examination.

Neither [beta]-agonists, chlorpheniramine, cromolyn diazapam, ipratropium, metoclopramide, ranitidine, systemic corticosteroids, nor theophylline improved his cough Partial relief was obtained with acetaminophen with codeine No. 3 four times daily and phenothiazines (chlorpromazine 10 mg four times daily, later changed to promethazine 25 to 50 mg four times daily).

Eighteen month later esophagogastroduodenoscopy was performed to evaluate fecal unrevealed blood; however, he was unable to tolerate the operation due to coughing. Nebulized lidocaine completely repressed his cough. The inquiry revealed severe erosive esophagogastritis.

athwart the past year, his symptoms have been well controll according to nebulized lidocaine (3 ml of 1 percent lidocaine) twice a day and acetaminophen with codeine No. 3 as distressed His only adverse reaction is mild hoarseness lasting several hours after each treatment. Serum lidocaine flats measured after several treatments have not been greater than 4.0 mg/dl He remains onward therapy with metoclopramide and ranitidine as prophylaxis for ebb esophagitis.

DISCUSSION

The cause of our patient's cough is unclear. The cough persisted despite cessation of ACE inhibitors.[3] ebb esophagitis may be contributing to his cough;[4] however, no ebb was identified on initial barium swallow and his symptoms have failed to improve forward maximal antireflux medications. Other studies failed to exhibit toxic serum levels after nebulization of 4 or 10 percent lidocaine.[2,5] Nebulized lidocaine exhibits several advantages over the traditional treatment of cough Antihistamines are frequently sedating and may dry secretions, paradoxically worsening the cough Phenothiazines may bring dystonic reactions, sedation, and tardive oral dyskinesia. This case glance ats nebulized lidocaine is tolerated well and effective therapy for intractable cough

ADDENDUM

Since acceptance of this manuscript for publication, brace additional patients with refractory cough have been treated favorably with nebulized lidocaine. The first received lidocaine for 2 month to treat a lisinopril-induced cough that persisted after cessation of the mix with drugs 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 bear up undered any adverse effects from the lidocaine.

REFERENCES

[1] Irwin R Rosen MJ Braman S Cough: a comprehensive review. Arch Intern M 1977; 137:1186-91

[2] Jakobsen CJ Ahlburg P Holdgard HO Olsen KH Thomsen A. Comparison of intravenous and topical lidocaine as a suppressant of coughing after bronchoscopy during general anesthesia. Acta Anaesthesiol Scand 1991; 35:238-41

[3] Kaufman J Casanova JE Riendl P Schlueter DP Bronchial hyperreactivity and cough appropriate to angiotensin-converting enzyme inhibitors. Chest 1989; 95:544-48

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