Initial symptomatic management of cough in palliative care

Homsi, 2001Molassiotis, 2010Molassiotis, 2017

Principles of managing cough in palliative care are discussed above.

Symptomatic management of cough in palliative care depends on whether the cough is dry or productive (moist or wet), and if the cause of cough is usually a corticosteroid-responsive condition.

Manage dry cough with nondrug interventions and a cough suppressant. Nondrug interventions include vocal hygiene and minimising environmental trigger factors (see Nondrug interventions in the Respiratory guidelines). A suitable cough suppressant regimen is:

Manage a productive (moist or wet) cough with education and training in techniques to clear sputum easily. This can include ‘Active Cycle of Breathing’ exercises or chest physiotherapy—see Nondrug interventions in the Respiratory guidelines.

A course of corticosteroid may be considered in patients with a cough associated with conditions that are usually corticosteroid-responsive (eg chronic obstructive pulmonary disease, radiation- or drug-induced pneumonitis, or malignant complications such as airway obstruction or lymphangitis carcinomatosis). If a corticosteroid is used, ensure there is a clear plan for when and how to stop the drug. Review therapy and avoid ongoing use of corticosteroids if there is no response. If the course of corticosteroid is effective, but cough relapses when the corticosteroid is stopped, seek specialist advice about the cause of cough and treatment plan. For advice on stopping corticosteroids, see Rationalising oral corticosteroids in palliative care.

If cough does not respond to initial symptomatic management, see Nonresponse to initial symptomatic management of cough in palliative care.