Chronic Cough Due to Lung Tumors: Summary of Recommendations

There have been few studies of benzonatate as a peripherally acting antitussive in the setting of pulmonary malignancies. In a case series, benzonatate effectively controlled cough in 80% of 21 patients with malignant pulmonary involvement, and it was effective for cough associated with lung cancer that was unresponsive to treatment with opioids in another small case series of three patients.
In summary, when considering other treatment methods to control cough caused by lung cancer, clinicians are left to use a variety of pharmacologic agents in an effort to relieve cough. There is little scientific rigor in most studies of pharmacologic approaches to cough suppression, and the efficacy of these pharmacologic methods is variable in the reported series.
For patients with cough and lung cancer, the use of centrally acting cough suppressants such as dihydrocodeine and hydrocodone is recommended. Level of evidence, low; benefit, intermediate; grade of recommendation, C.  In a patient with cough who has risk factors for lung cancer or a known or suspected cancer in another site that may metastasize to the lungs, a chest radiograph should be obtained. Level of evidence, expert opinion; benefit, substantial; grade of recommendation, E/A canadian health & care mall

In patients with a suspicion of airway involvement by a malignancy (eg, smokers with hemoptysis), even when the chest radiograph findings are normal, bronchoscopy is indicated. Level of evidence, low; benefit, substantial; grade of recommendation, B
For patients with stage I and II NSCLC, surgery to remove the NSCLC is the treatment of choice. If cough was caused by a NSCLC that can be surgically removed, the cough will typically cease.
Level of evidence, low; benefit, substantial; grade of recommendation, B
For patients with more advanced NSCLC (stages III and IV), external beam radiation and/or chemotherapy should usually be offered. Level of evidence, good; benefit, intermediate; grade of recommendation, A
For patients with dyspnea or hemoptysis due to endobronchial tumors, cough may also be present. Endobronchial methods should be considered for the palliation of these symptoms, but cough alone is seldom a reason to offer such treatment. Level of evidence, fair; benefit, small; grade of recommendation, C
For patients with cough and lung cancer, the use of centrally acting cough suppressants such as dihydrocodeine and hy-drocodone is recommended. Level of evidence, low; benefit, intermediate; grade of recommendation, C

This entry was posted in Respiratory Symptoms and tagged ablative methods, antitussives, brachytherapy, bronchoscopy, chemotherapy, electrocautery, endobronchial treatment, laser, lung cancer, metastatic carcinoma (to lungs), radiation therapy, stents, Surgery.