Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough

Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions.A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches.The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations.Cough is a common symptom in about 23-37% of general cancer patients and 47-86% of lung cancer patients [1]. The first author's data on 100 cancer patients assessed using the Memorial Symptom Assessment Scale from the beginning of cancer treatment to 3, 6 and 12 months showed a prevalence of 42.9%, 39.2%, 35.1% and 36.1% respectively, similarly to the experience of breathlessness, although less distressing than breathlessness [2]; these numbers almost doubled in the lung cancer subgroup analysis. Despite such high prevalence, the management of cough remains suboptimal, with little high quality evidence to guide practice. Much of the current practice on the symptomatic management of cough in lung cancer is experiential and primarily is geared around the use of oral opioids. Current guidelines on the management of cough are often broad and non