Overview
Psychogenic cough, often seen in patients with chronic cough unresponsive to standard treatments, is characterized by persistent coughing without an identifiable organic cause, significantly impacting quality of life 1.Diagnosis
Clinical evaluation focusing on history and ruling out organic causes through relevant investigations (e.g., chest imaging, pulmonary function tests) 1.
Identification of psychological triggers or stressors through psychiatric evaluation 1.Management
First-line treatments: Cognitive-behavioral therapy (CBT) and reassurance 1.
Adjunctive treatments: Nebulized lidocaine (1-4%) for rapid cough suppression, effective in 70% of cancer patients within 15 minutes, lasting 2-4 hours 1.
- Monitor for transient side effects such as oropharyngeal numbness (15%) and bitter taste (10%) 1.
- Exercise caution in asthmatic patients due to potential bronchoconstriction (FEV1 decline ≥15% in 25% of cases, reversible with bronchodilators) 1.Special Populations
Elderly: Nebulized lidocaine can be considered, but close monitoring for side effects is essential 1.
Comorbidities: Asthma patients require careful evaluation due to increased risk of bronchoconstriction 1.Key Recommendations
Consider nebulized lidocaine (1-4%) for rapid relief of intractable cough in palliative care settings, particularly in cancer patients, with close monitoring for transient side effects (Evidence: Moderate) 1.
Prioritize psychological interventions such as cognitive-behavioral therapy for managing psychogenic cough (Evidence: Expert opinion) 1.
Exercise caution and monitor respiratory function closely when administering nebulized lidocaine to patients with asthma (Evidence: Moderate) 1.References
1 Pan J, Khan AA, Yu W, Rui L. "Nebulized lidocaine for intractable cough in hospice care: a comprehensive review of efficacy, safety, and future perspectives". BMC palliative care 2025. link