CHEST Guidelines-Symptomatic-Treatment-of-Cough-Among-Adult-Patient (2)

Symptomatic-Treatment-of-Cough-Among-Adult-Patient (2)

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The 2017 CHEST Guideline and Expert Panel Report provides an updated framework for the symptomatic treatment of cough in adult lung cancer patients. Despite its prevalence, affecting 57% of lung cancer patients, cough remains an oft-undertreated symptom, partly due to sparse, low-quality evidence. Reflecting this, the panel’s recommendations emphasize a step-up approach to management based on a combination of pharmacologic and nonpharmacologic strategies.<br /><br />Key strategies include comprehensive assessment to identify co-existing causes of cough and applying treatments such as cough suppression exercises, where available, as alternatives or complements to pharmacological therapies. Should these initial approaches fail, more specific interventions are recommended. Endobronchial brachytherapy is suggested for patients unfit for surgery, chemotherapy, or external radiation; other effective pharmacologic interventions may involve trialing demulcents and opiate derivatives such as codeine or morphine. If opioid treatment is ineffective, peripherally acting antitussives or potential trials with local anesthetics like nebulized lidocaine may be beneficial. <br /><br />For cases of opioid-resistant cough that persist despite these strategies, the guidelines propose considering N-of-1 randomized controlled trials with medications such as gabapentin or baclofen, albeit these possess uncertain efficacy and substantial side effect profiles. Given the poor quality of current evidence, the report underscores an urgent need for further research, aiming to enrich treatment options through rigorous methodologic studies and enhance patient quality of life.<br /><br />Future research avenues outlined include enhancing nonpharmacologic treatments, validating symptom management by testing over-the-counter medications, and exploring the impacts of smoking cessation on cough symptoms. The guideline's recommendations highlight the importance of continuous evaluation beyond primary cancer treatments, emphasizing the integration of patient feedback and innovative trial designs to improve outcomes for patients enduring chronic cough due to lung cancer.

Keywords

CHEST Guideline

cough treatment

lung cancer

pharmacologic strategies

nonpharmacologic strategies

endobronchial brachytherapy

opioid-resistant cough

gabapentin

smoking cessation

symptom management