Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer
Publication Date: April 1, 2017
Last Updated: March 14, 2022
Recommendations
1. In adult patients with cough associated with lung cancer that persists despite cancer treatment, we suggest, as a first step, that a comprehensive assessment according to a published, evidence-based management guideline be undertaken to identify any co-existing causes linked with cough and initiate treatment accordingly. (U-CBS)
315340
2. In adult patients with lung cancer experiencing cough despite anticancer treatment, we suggest cough suppression exercises as alternative or additional to pharmacological therapy where such services are available. (2C)
315340
3. In adult patients with cough due to localized endobronchial disease for whom surgery, chemotherapy, or external beam radiation are not indicated, we suggest the use of endobronchial brachytherapy where such specialist facilities are available and in suitable patients. (2C)
315340
4. In adult patients with lung cancer who require a pharmacological approach for the treatment of cough, we suggest an initial trial with demulcents such as butamirate linctus (syrup) or simple linctus (syrup) or glycerin-based linctus (syrup) where available. (2C)
315340
5. In adult patients with lung cancer experiencing cough that does not respond to demulcents, we suggest pharmacological management using an opiate-derivative titrated to an acceptable side-effect profile. (2C)
315340
6. In adult patients with lung cancer experiencing opioid-resistant cough, we suggest a peripherally-acting antitussive (where available), such as levodropropizine, moguisteine, levocloperastine or sodium cromoglycate. (2C)
315340
7. In adult patients with lung cancer experiencing opioid-resistant cough that does not respond to peripheral antitussives, we suggest a trial with local anesthetics, including nebulized lidocaine/bupivacaine or benzonatate. (U-CBS)
315340
8. In adult patients with intractable cough due to lung cancer in whom surgery, chemotherapy, external beam radiation, brachytherapy and the previously mentioned nonpharmacological and pharmacological approaches are ineffective or not indicated, we suggest that clinicians consider performing N-of-1 randomized controlled trials to determine if any of the following drugs might be of benefit in controlling cough because none have been definitively shown to be effective nor devoid of side effects: diazepam, gabapentin, carbamazepine, baclofen, amitriptyline, thalidomide. (U-CBS)
315340
Recommendation Grading
Overview
Title
Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer
Authoring Organization
American College of Chest Physicians
Publication Month/Year
April 1, 2017
Last Updated Month/Year
August 2, 2023
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Cough among patients with lung cancer is a common but often undertreated symptom. We used a 2015 Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic.
Target Patient Population
Patients experience cough with lung cancer
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Home health, Hospice, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D008175 - Lung Neoplasms, D003371 - Cough
Keywords
lung cancer, cancer, cough