In some patients, chronic coughing may be the source of major suffering. Chronic cough can cause pain, interfere with sleep, aggravate dyspnea, and worsen fatigue. The causes of cough can be classified much like the causes of dyspnea.
One approach to chronic cough in palliative care patients is to consider the differential diagnoses summarized below:
There have been times when it felt like I went back to being the same person. I didn't turn to God and become born again. I didn't retreat from big city life or remain vegetarian or macrobiotic. Other times I think I have been completely shaped by those experiences. I think my life has become about trying hard to move beyond the cancer.
Cough-suppressing agents such as opioids are commonly utilized. Anecdotal evidence suggests a role for inhaled local anesthetics, which should be utilized judiciously and sparingly; they are unpleasant to the taste and obtund the gag reflex, and anaphylactic reactions to preservatives in these solutions have been documented. Opioid and nonopioid antitussives, such as dextromethorphan, may act synergistically, but further studies are required to confirm this hypothesis. Gabapentin was found to be efficacious compared with placebo for chronic refractory cough, although this study did not specifically include cancer patients.
In cases of increased sputum production, expectorants and mucolytics have been employed, but the effects have not been well evaluated. Inhaled sodium cromoglycate has shown promise as a safe method of controlling chronic coughing related to lung cancer.
Dudgeon DJ, Rosenthal S: Management of dyspnea and cough in patients with cancer. Hematol Oncol Clin North Am 10 (1): 157-71, 1996.
Ryan NM, Birring SS, Gibson PG: Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet 380 (9853): 1583-9, 2012.
Moroni M, Porta C, Gualtieri G, et al.: Inhaled sodium cromoglycate to treat cough in advanced lung cancer patients. Br J Cancer 74 (2): 309-11, 1996.
In this article
This information is produced and provided by the National
Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National
Institute via the Internet web site at http://
.gov or call 1-800-4-CANCER.
WebMD Public Information from the National Cancer Institute
May 28, 2015
This information is not intended to replace the advice of a doctor.
Healthwise disclaims any liability for the decisions you make based on this