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)
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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)
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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)
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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)
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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)
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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)
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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)
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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)
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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