CHEST Guidelines-Symptomatic-Treatment-of-Cough-Among-Adult-Patient (1)

Symptomatic-Treatment-of-Cough-Among-Adult-Patient (1)

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The "Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report" addresses the management of cough, a prevalent yet often undertreated symptom of lung cancer. Building upon a 2006 guideline, this update utilizes data from a 2015 Cochrane systematic review and other studies to propose detailed recommendations through a Delphi consensus method.

Key recommendations include: 

1. <strong>Comprehensive Assessment:</strong> Initial management involves a thorough evaluation to identify treatable causes of cough persisting post-cancer treatment (Ungraded, Consensus-Based).
   
2. <strong>Nonpharmacologic Interventions:</strong> Incorporate cough suppression exercises as alternatives or additions to pharmacologic treatment, where available (Grade 2C).

3. <strong>Endobronchial Brachytherapy:</strong> For patients with localized endobronchial disease ineligible for surgery, chemotherapy, or external radiation, referral for brachytherapy is suggested (Grade 2C).

4. <strong>Pharmacologic Treatments:</strong> Initial trials with demulcents, such as butamirate linctus, and progressing to opiate derivatives like hydrocodone for more severe cases (Grade 2C). For coughs resisting opioids, peripherally acting antitussives like levodropropizine and, if needed, local anesthetics such as nebulized lidocaine are recommended.

The guideline emphasizes the limited quality of current evidence and calls for high-quality research to support more effective interventions. The recommendations propose a structured approach, incorporating both pharmacologic and nonpharmacologic methods, while urging further investigation into understudied areas such as the role of smoking cessation and the management of comorbid conditions like COPD in lung cancer patients. The guideline also advises on conducting N-of-1 trials for experimental treatments when conventional approaches fail, stressing the importance of personalized care to improve patient quality of life.

Keywords

lung cancer

cough management

CHEST guideline

Delphi consensus

nonpharmacologic interventions

endobronchial brachytherapy

pharmacologic treatments

demulcents

opioid derivatives

personalized care