Principles of managing cough in palliative care

Cough is a common and distressing symptom in patients with advanced lung disease and lung cancer. Cough significantly reduces quality of life; however, it is under-recognised and undertreated in patients with palliative care needsMolassiotis, 2017Ryan, 2018.

When managing cough in palliative care, consider the potential benefits and burdens of investigations and treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

The approach to management of cough in palliative care depends on whether the aim is symptomatic management or active (disease-modifying) treatment. Regardless of the approach, assess the patient and address contributing cause(s) of the cough if possible. This includes identifying possible causes, contributing factors (eg comorbidities) and triggers of cough through an assessment that includes a thorough medical history. The principles of assessment outlined in the Respiratory guidelines apply to patients with palliative care needs.

In addition to the common or important causes of acute cough and chronic cough listed in the Respiratory guidelines, additional causes of cough to consider in patients with advanced cancer include:
  • vocal cord paralysis
  • tracheo-oesophageal fistula
  • superior vena cava obstruction
  • pleural effusion or pericardial effusion
  • lung cancer or metastases causing endobronchial disease with resultant obstruction or infection, parenchymal infiltration or lymphangitis carcinomatosis
  • adverse effects of treatment (eg radiation pneumonitis, pneumonitis associated with monoclonal antibody therapy).

If symptomatic management is the agreed plan, see Initial symptomatic management of cough in palliative care.

If the agreed plan is for active (disease-modifying) treatment, follow the principles of management for cough outlined in the Respiratory guidelines.