Coughing

Coughing is a natural reflex.  However, it can be irritating and affecting daily life if it persists.

Cough can be caused by various reasons. Occasionally, there may be more than a single cause for cancer patients.

• Cancer 
  • Cancer that affects the upper respiratory tract, e.g. lung cancer, thymus cancer, cancer of the pleura
  • Any cancer that has spread to the lungs or chest
• Anti-cancer treatment 
  • Some anti-cancer treatments can cause inflammation of the lung.
  • For example:
    • Chemotherapy: bleomycin, methotrexate
    • Oral targeted agents: osimertinib, everolimus
    • Immunotherapy: pembrolizumab, nivolumab, durvalumab
    • Radiotherapy to the chest 
    • Hormonal therapy: fulvestrant (Faslodex), letrozole (Femara)
• Other medications 
  • Nonsteroidal anti-inflammatory drugs (NSAIDS): e.g. aspirin
  • Angiotensin-converting enzyme inhibitors (ACEi): used to treat high blood pressure and heart disease
• Cancer-related complications
  • Pneumonia
  • Pleural effusion: A pleural effusion is a build-up of extra fluid in the space between the lungs and the chest wall. About half of cancer patients develop pleural effusion.
  • Pulmonary embolism: refers to blood clot in the lungs
  • Superior vena cava syndrome (SVCS): SVCS happens when the superior vena cava is partially blocked or compressed by tumour
• Other diseases in the lung or heart
  • Asthma, nasal reflux, acid reflux
  • Chronic lung diseases, such as bronchiectasis or interstitial lung disease
  • Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis
  • Upper respiratory tract infection
  • Heart disease such as heart failure 
  • Pleural effusion

What can worsen coughing?

• Smoking cigarette or exposure to second hand smoke
• Allergens, such as pollen, mold, and dust.
• Postnasal drip
• Cold
• Flu
• Bronchitis, pneumonia

• Tell the doctor about the cough.
  • You should tell the doctor about the severity and duration of cough, any factors that would improve or worsen it, and any other symptoms like shortness of breath, chest pain, fever, heartburn and vomiting.
• You may need the following tests for diagnosis.
  • Chest X-ray
  • Computed tomography (CT or CAT) scan
  • Echocardiogram: This is a ultrasound of the heart to check for any heart failure.

Healthcare professionals will provide appropriate treatment based on the causes of the symptom.

Depending on the clinical conditions, doctors will use medications to control the cough symptom.

Common medications include:

• Mucus-loosening expectorants, such as guaifenesin, fluimucil
• Cough suppressants, such as benzonatate, codeine, and dextromethorphan
• Decongestants
• Antihistamines

• Avoid factors that cause coughing, such as cold air, cold drinks or foods containing fruit acids.
• Do some light workout can help open airways.
• Drink lots of liquid and stay hydrated, it helps thin mucus in the throat.
• Use warm drinks with honey.
• Avoid smoking and inhalation of second-hand smoke.
• Take hot, steamy showers to loosen the mucus.
• Use relaxation techniques, such as deep breathing.
• Use cough drops.
• Use a humidifier in dry rooms.
• Try deep breathing exercises.
• Clear the airways using different body positions, which is called postural drainage.

Smart patient (by Hospital Authority): Coughing 

American Society of Clinical Oncology (ASCO): Cough