Cough among patients with lung cancer is a common but often undertreated symptom. We have used a recent Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the CHEST 2006 guideline on this topic.
The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context. Final grading was reached by consensus according to Delphi methodology.
The Cochrane systematic review identified 17 trials of primarily low quality evidence. Such evidence was related to both non-pharmacological (cough suppression) and pharmacological treatments (demulcents, opioids, peripherally-acting antitussives or local anesthetics) as well as endobronchial brachytherapy.
Compared with the 2006 CHEST Cough Guidelines, the current recommendations and suggestions are more specific and follow a step-up approach to the management of cough among patients with lung cancer, acknowledging the low quality evidence in the field and the urgent need to develop more effective, evidence-based interventions through high quality research.