"Nebulized lidocaine for intractable cough in hospice care: a comprehensive review of efficacy, safety, and future perspectives".

BACKGROUND AND

OBJECTIVE

Intractable cough, affecting 10-50% of terminally ill patients, significantly impairs quality of life. Conventional therapies often fail due to dose-limiting side effects or inadequate efficacy, necessitating alternative treatments. This review evaluates the efficacy, safety, and clinical applicability of nebulized lidocaine for managing intractable cough in hospice care.

METHODS

A systematic literature search (1973-2023) across PubMed, MEDLINE, Embase, and Cochrane Library identified studies on nebulized lidocaine in hospice or palliative populations. Inclusion criteria the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Data on cough reduction, side effects, and dosing were synthesized thematically.

RESULTS

Among 265 screened studies, 58 met inclusion criteria. Nebulized lidocaine (1-4%) demonstrated rapid cough suppression (within 15 min) in 70% of cancer patients, with effects lasting 2-4 h. Mild side effects, including oropharyngeal numbness (15%) and bitter taste (10%), were transient. However, 25% of asthmatic patients experienced bronchoconstriction (forced expiratory volume in 1 s FEV1FEV1 decline ≥ 15%), resolving with bronchodilators. Lidocaine reduced opioid reliance and improved comfort in 80% of cases. Variability in efficacy was noted, with limited benefits in severe chronic obstructive pulmonary disease (COPD) with acute respiratory failure.

CONCLUSION

Nebulized lidocaine offers a safe, non-invasive option for intractable cough in hospice care, minimizing systemic side effects. Its rapid action and compatibility with opioid-sparing regimens enhance palliative outcomes. However, cautious use is warranted in asthma and (COPD) due to bronchoconstriction risks. Future research should prioritize standardized dosing, long-term safety, and Randomized controlled trials(RCTs in diverse hospice populations.