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Palliative cancer care - cough - Management
What should I ask about the cough?
- Ask about:
- The effect on the person's life.
- The features of the cough.
- Associated symptoms.
Clarification / Additional information
- Ask about the:
- Impact on the person's quality of life. For more information, see Complications of cough.
- Severity, time of onset, and duration of the cough.
- Pattern and character of the cough, for example [Warrell et al, 2003]:
- Dry cough, persisting over weeks — suggests that the cough is due to the person's cancer.
- Dry cough, barking quality, short lived — pharyngitis, tracheobronchitis, early pneumonia.
- Harsh, hoarse 'croup' sound — laryngitis.
- Prolonged, low 'bovine' cough — left recurrent laryngeal nerve palsy from compression by thoracic lesions (e.g. carcinoma of the bronchus, hilar lymph nodes) causes abductor paralysis of the vocal cords.
- Hard, metallic-sounding 'brassy' cough — tracheal compression from intrathoracic lesions (may be associated with wheeze or stridor).
- Loose cough — secretions moving in the major airways (these may or may not be expectorated).
- Coughing with food or after a meal — aspiration from oesophageal or pharyngeal disease.
- Enquire about associated symptoms:
- Nasal discharge — cough may be caused by post-nasal drip.
- Sputum:
- Purulent sputum — infection.
- Frothy sputum — left ventricular failure, or rarely, alveolar cell cancer.
- Non-infected sputum — jelly-like, white or clear.
- Infected sputum — thick, yellow or green.
- Mucus — large amounts (> 100 mL per day) are produced by people with bronchorrhoea, which can occur as a result of bronchiolo-alveolar cancer, asthma, or tuberculosis.
- Blood — haemoptysis from tumour, or tumour erosion. This is the presenting symptom in 5%, and occurs at some stage in 50%, of people with lung cancer [Warrell et al, 2003].
- Dyspnoea — effusion, lung collapse, lymphangitis carcinomatosa. For more information on causes and management of dyspnoea, see the CKS topic on Palliative cancer care - dyspnoea.
[Twycross and Wilcock, 2001; Warrell et al, 2003; Doyle et al, 2004; Zylicz, 2004]
Basis for recommendation
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