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Evidence-Based Medicine |

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guidelines and Expert Panel Report FREE TO VIEW

Alex Molassiotis, RN, PhD; Jaclyn A. Smith, MBChB, MRCP, PhD; Peter Mazzone, MD, MPH; Fiona Blackhall, FRCP, PhD; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

Conflict of Interests: AM reports grants and honoraria from MSD Merck; JS is a named inventor on a patent owned by the University Hospital of South Manchester, which describes novel techniques for detecting cough from sound recordings. This patent is licensed to a medical device company, but Dr Smith has not received any financial rewards as a result. The initial Cochrane systematic review and the subsequent update was carried out by AM and JS; PM, FB and RSI report no financial or intellectual conflicts of interest regarding the content of this manuscript. Moreover, while RSI is the Editor in Chief of CHEST, the review and all editorial decisions regarding this manuscript were independently made by others.

aSchool of Nursing, The Hong Kong Polytechnic University

bCentre for Respiratory Medicine and Allergy, University of Manchester and University Hospital of South Manchester, UK

cRespiratory Institute, Cleveland Clinic, Cleveland, OH, USA

dDepartment of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK

eUniversity of Massachusetts Medical School, Worcester, MA, USA

Corresponding author Alex Molassiotis, RN, PhD Chair Professor of Nursing and Head of School School of Nursing The Hong Kong Polytechnic University Hung Hom, Kowloon Hong Kong.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2016.12.028
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Abstract

Background  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.

Methods  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.

Results  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.

Conclusions  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.


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