Cough may persist in the setting of lung cancer, despite all other treatments that are directed at the cancer and the associated symptom of cough. When cough persists, most patients will be offered pharmacologic therapy that is designed to control cough. The use of various protussive and antitussive pharmacologic agents is evaluated extensively elsewhere in these guidelines.
When a comorbid disease that causes cough is present together with lung cancer, pharmacologic treatment of the comorbid disease may provide relief from the cough. Thus, the use of bronchodilators and corticosteroids for the treatment of chronic bronchitis and asthma, for example, may improve cough in a patient who also has lung cancer. There are no data to support this approach, but it is an approach that is commonly used by clinicians. Therapy with broncho-dilators and corticosteroids likely will not improve cough if the cough is caused by the cancer itself. comments
The pharmacologic agents that are available when cancer is the cause of cough include the following two classes of antitussive drugs: (1) those with central activity (ie, opioids and nonopioids); and (2) those with peripheral activity, the action of which can be direct or indirect. Not all of the drugs to manage cough are available throughout the world. Antitussive drugs that have been studied extensively include codeine, hydrocodone, and dextromethorphan. Each of these agents has been demonstrated to be effective and has a good safety profile. The drugs that have been specifically studied in the setting of cancer and improvement in cough related to the cancer are hydrocodone, dihydrocodeine, levodropropizine, sodium cromoglycate, and benzonatate. While each of these agents has been shown to be effective and safe primarily in case series of variable size, we are unaware of any randomized, prospective, double-blind, placebo-controlled trials of pharmacologic agents to control cough in the specific setting of lung cancer.