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Open Access Highly Accessed Review

Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough

Alex Molassiotis1*, Jaclyn A Smith2, Mike I Bennett3, Fiona Blackhall4, David Taylor5, Burhan Zavery6, Amelie Harle4, Richard Booton7, Elaine M Rankin8, Mari Lloyd-Williams9 and Alyn H Morice10

Author Affiliations

1 School of Nursing, University of Manchester, UK

2 School of Translational Medicine, University of Manchester, UK

3 School of Health & Medicine, Lancaster University, UK

4 Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK

5 Department of Thoracic Medicine, Wycombe Hospital, Buckinghamshire, UK

6 Oncology Pharmacy, Clatterbridge Centre for Oncology NHS Foundation Trust, Bebington, UK

7 Department of Respiratory Medicine, Wythenshawe Hospital, Manchester, UK

8 Department of Cancer Medicine, Ninewells Hospital, Dundee, UK

9 School of Population, Community and Behavioural sciences, University of Liverpool, UK

10 Department of Academic Medicine (Chest), University of Hull, UK

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Cough 2010, 6:9  doi:10.1186/1745-9974-6-9

Published: 6 October 2010

Abstract

Background

Cough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice.

Methods

Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions.

Results

A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches.

Conclusion

The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations.