CHEST Guidelines-Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer

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The "CHEST Guideline and Expert Panel Report" provides updated recommendations for the symptomatic treatment of cough in adult patients with lung cancer, building on a 2006 guideline from the American College of Chest Physicians. Lung cancer patients often experience a challenging cough that can affect their quality of life and remains inadequately managed with existing treatments.<br /><br />A Cochrane systematic review conducted in 2015 identified 17 clinical trials with generally low-quality evidence related to both pharmacologic (such as opioids and demulcents) and non-pharmacologic treatments (like cough suppression exercises). These trials also explored specialized interventions such as endobronchial brachytherapy.<br /><br />The guidelines adopt a step-up approach, beginning with comprehensive assessments using evidence-based management guidelines to address any co-existing causes of cough. Recommendations suggest using cough suppression exercises as either alternative or additional therapy where appropriate services exist. For localized endobronchial disease where surgery or conventional radiation isn't suitable, endobronchial brachytherapy is considered if it is available.<br /><br />Initial pharmacological treatment may involve demulcents like simple syrup linctus. If these are ineffective, opiate-derivatives are recommended, adjusted to suit patient needs and side effects. Pharmacological management of opioid-resistant cough might involve peripherally-acting antitussives, such as levodropropizine. Local anesthetics like nebulized lidocaine are suggested for cases unresponsive to other treatments.<br /><br />In situations where all traditional and standard treatments fail, the guidelines propose considering individualized "N-of-1 randomized controlled trials" to evaluate experimental therapies, acknowledging the limitations and risks due to the lack of robust evidence.<br /><br />Noting significant evidence gaps, the report emphasizes the need for further research, urging high-quality trials to develop better cough management strategies for lung cancer patients.

Keywords

CHEST Guideline

lung cancer

cough treatment

American College of Chest Physicians

systematic review

endobronchial brachytherapy

pharmacologic treatments

cough suppression exercises

opioid-resistant cough

N-of-1 trials