1 / 16

Management of cough in lung cancer

Management of cough in lung cancer. Clinical guidelines for the management of cough in lung cancer: report of a UK Task Group on Cough. Molassiotis A 1 , Smith JA 2 , Bennett MI 3 , Blackhall F 4 , Taylor D 5 , Zavery B 6 , Harle A 4 , Booton R 7 ,

rebecca-odom
Download Presentation

Management of cough in lung cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Management of cough in lung cancer

  2. Clinical guidelines for the management of cough in lung cancer: report of a UK Task Group on Cough. Molassiotis A1, Smith JA2, Bennett MI3, Blackhall F4, Taylor D5, Zavery B6, Harle A4, Booton R7, Rankin EM8, Lloyd-Williams M9, Morice AH10.

  3. Epidemiology • Cough is common symptom • 23-37% of all cancer patients • 47-86% in lung cancer • Not always well managed • Little evidence to guide practice

  4. Formation of task group • Literature reviews • Peer review by UK committees • Submitted for publication

  5. Pathophysiology • Coughing serves to protect airway from irritants • Stimuli provoke cough via vagus nerve through • chemoreceptors (C fibres) • mechanoreceptors (A delta fibres)

  6. In lung cancer • Ulceration of mucosa • Mechanical stimulation • Release of inflammatory mediators • Chemoreceptor stimulation • Sensitises peripheral nerves • Also: • Obstruction • Pleural effusion • Infection • Fistulas • Carcinomatosis

  7. Recommendations

  8. Assessment • History • Type of cough (productive / non-productive) • Trigger factors • Nocturnal or day time • Co-morbid conditions • COPD • Heat failure • No validated symptom scale available

  9. Assessment • Drugs causing cough • Methotrexate • Bleomycin • ACE inhibitors • Further investigations • ?CXR • CT

  10. Treat reversible causes • COPD / asthma • Inhaled bronchodilators • Steroid (prednisolone 30mg daily) • Infection (bronchietctasis, LRTI) • antibiotics • GI reflux • PPI (omeprazole) • Metoclopramide or domperidone for non-acid reflux-

  11. Treat the cancer • Chemo • Improves symptoms including cough • External radiotherapy • Brachytherapy

  12. Symptomatic management • Linctus • Glycerol • Simple linctus • Trial of steroid • Prednisolone • (or dexamethasone)

  13. Centrally acting agents • Codeine • 30mg qds • Morphine or methadone • If codeine no help • Morphine 5-10mg bd • No dose response relationship for cough

  14. Peripherally acting agents • Antitussive agents • Levodropropizine, • Moguisteine • Levocloperastine • Local anaesthetic agents • nebulised bupivacaine • benzonatate

  15. In general • Low levels of evidence for these recommendations • Peripheral and intermittent approaches before central and continuous treatment • In lung cancer • many patients already on opioids for pain • Central approaches maximised already

  16. EXPERIMENTAL Carbamazepine, Thalidomide, Gabapentin, Baclofen Amitriptylline LOCAL ANAESTHETICS Nebulised Lidocaine Benzonatate PERIPHERALLY-ACTING ANTITUSSIVES Levodropropizine, Moguisteine, Levocloperastine adjunctive therapies, anxiety management and vocal hygiene techniques OPIOIDS Morphine/Methadone Dextromethorphan, Codeine, Hydrocodone CONSIDER ORAL STEROID TRIAL 2 weeks CANCER SPECIFIC systemic chemotherapy/RT endobronchial therapy, PDT, palliative RT CO-MORBIDITIES COPD, reflux, asthma, infections

More Related