Opioids appear to be the best cough suppressants in patients with lung cancer. Dihydrocodeine and hydrocodone are the most widely used opioids. In a phase II dose-titration study of 25 patients with advanced cancer who have cough, 5 mg of hydro-codone was administered twice daily. The dose was increased daily until there was an improvement of > 50% in the frequency of cough and then was maintained for 3 consecutive days. The median best response was 70% in cough frequency, which was achieved with a median hydrocodone dose of 10 mg/d (range, 5 to 30 mg/d). A double-blind randomized trial in 140 patients with lung cancer compared levodro-propizine drops (75 mg tid) to dihydrocodeine drops (10 mg tid for 7 days). The subjective severity of cough was significantly reduced with the use of both drugs, which had similar antitus-sive effects and duration of cough suppression. Adverse effects were infrequent in both groups, but the degree of somnolence was lower in the group treated with levodropropizine (8%) than among those treated with dihydrocodeine (22%). Levodropropizine is not available in the United States. canadian health&care mall
It is well-known that placebo administration can be associated with significant suppression of cough, especially in patients with acute cough due to upper respiratory infections. This issue should be considered not only when evaluating investigations on the suppressant effects of a single active drug, but also in studies comparing two active drugs, such as the report on levodropropizine and dihydrocodeine. However, to our knowledge, there have been no studies documenting the magnitude of the placebo effect on chronic cough due to pulmonary neoplasms.
Moroni et al hypothesized that inhaled sodium cromoglycate might reduce cough associated with lung cancer. Sodium cromoglycate had previously been reported to be effective for treating cough due to angiotensin-converting enzyme inhibitors, possibly because of the inhibition of afferent unmyelinated C-fiber activation. A role for C-fibers in cancer-related cough, both from the release of bra-dykinin by neoplastic cells and from the mechanical stimuli of the endings of the C-fibers caused by distortion by the cancer, was postulated. In a prospective, double blind, placebo-controlled trial, a statistically significant reduction in cough was observed in all patients with advanced lung cancer who were treated with sodium cromoglycate. This study enrolled only 20 patients, and the results have not been repeated in a larger group of patients with lung cancer.