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Palliative cancer care - cough - Management
How should I manage a person with a cough of known cause other than infection?

  • Determine with the person, and their carers and family, what management interventions are appropriate for the underlying cause of cough and the stage of illness, for example:
    • Treatment of the underlying cause of the cough if possible.
    • Referral for treatment of the underlying malignancy if needed (e.g. radiotherapy to a tumour, drainage of a pleural effusion).
    • Referral if the cause of the cough is not directly related to the underlying malignancy, but is more appropriately managed in secondary care (e.g. worsening chronic obstructive pulmonary disease).
    • Admission to hospital (e.g. acute exacerbation of heart failure).
  • If treatment of the underlying cause is not possible, or does not relieve the cough, consider symptomatic treatment (e.g. to enhance the effectiveness of, or suppress, the cough).
Clarification / Additional information
  • Treatment will depend on the cause:
    • The management of malignant causes of cough (e.g. tumour) should involve a specialist in view of the need to tailor treatment to the person's underlying malignancy and co-existing problems, and the large variety of treatments available. These include radiotherapy, aspiration of a pleural effusion, or corticosteroids.
    • If drugs (e.g. angiotensin-converting enzyme inhibitors) are thought to be causing the cough, review the person's medication, as it may be appropriate to stop certain drugs or switch to an alternative [Pan-Glasgow Palliative Care Algorithm Group, 2005].
    • Bronchorrhoea will necessitate specialist advice, as many different treatments (e.g. radiotherapy, chemotherapy, antimuscarinic drugs, nebulized terbutaline, nebulized indometacin, or octreotide) have been tried with variable success [Doyle et al, 2004].
  • There are separate CKS topics which deal with the management of common causes of cough. These will usually be managed in primary care, but in some cases admission to hospital, or secondary care advice may be necessary. For more information, see the CKS topics on:
  • Symptomatic treatment of cough will depend on whether this is appropriate for the person, and whether the cough is dry, moist and productive, or moist and non-productive. For more information, see When to consider symptomatic treatment.
Basis for recommendation

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