CHEST Guidelines-Symptomatic-Treatment-of-Cough-Among-Adult-Patient

Symptomatic-Treatment-of-Cough-Among-Adult-Patient

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The CHEST guideline update addresses the symptomatic treatment of cough in adult patients with lung cancer, a frequently neglected symptom. This update builds upon the 2006 CHEST guideline, drawing from a 2015 Cochrane review and other studies. Cough in lung cancer patients occurs in approximately 57% of cases and significantly affects quality of life, yet remains under-researched and inconsistently managed in clinical settings. The guideline suggests a comprehensive approach to cough management, targeting treatable causes alongside considering specific therapies. Initial steps should include a thorough assessment to identify underlying causes like tumor effects, infections, or comorbid conditions such as COPD or gastroesophageal reflux disease. Non-pharmacologic therapies like cough suppression exercises are recommended alongside pharmacologic options when applicable. The guideline emphasizes endobronchial brachytherapy for specific cases and pharmacologic treatments with demulcents or opioids, progressing to local anesthetics for resistant cases. In scenarios where traditional treatments are ineffective, N-of-1 trials may be considered to test unconventional drugs for their efficacy in controlling cough. However, evidence quality remains low, underscoring the need for high-quality research to bolster existing recommendations. The recommendations incorporate a step-up treatment approach and stress the necessity of ongoing research, especially regarding the complex interplay of symptoms like cough and other respiratory issues in lung cancer. The authors highlighted areas needing further investigation, including the effectiveness of smoking cessation, symptom management within symptom clusters, and the role of non-pharmacologic interventions. The CHEST report calls for broader acknowledgment of the significant impact of cough on lung cancer patients and a more consistent and evidence-driven treatment strategy.

Keywords

CHEST guideline

cough treatment

lung cancer

symptom management

pharmacologic therapies

non-pharmacologic interventions

endobronchial brachytherapy

N-of-1 trials

quality of life

research needs