Waikato DHB Palliative Care Guidelines

7. Cough

7.1 Dry cough 7.2 Productive cough Cough is a common symptom of primary and metastatic lung cancer and lymphangitis and can be stimulated by reflux oesophagitis.

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Cough is a common symptom of primary and metastatic lung cancer and lymphangitis and can be stimulated by reflux oesophagitis.

When patients are exhausted and no longer able to clear sputum it may be appropriate to suppress the cough.

Antibiotics may be a useful palliative treatment and reversible airways obstruction should be identified.

A different approach is required for the management of dry cough and productive cough.

7.1 Dry cough

Nebulised saline.

Pholcodine linctus (Duro-tuss™) – this is an antitussive and does NOT contain codeine phosphate.
Dose: 10-15mls up to four times daily.

Morphine or methadone elixir – low dose regularly or PRN.

Steroids – either prednisone 20-40mg mane or dexamethasone 4mg mane – aim to reduce gradually to lowest effective dose.

7.2 Productive cough

Physiotherapy.

Ipratropium (Atrovent™) or Combivent™ nebulisers.

Saline nebulisers may be useful in breaking down viscid secretions.

Buscopan 20mg subcut q3-4hrly

Oral steroids if bronchoconstriction is suspected.

Trial of antibiotics may be appropriate if infection suspected.

Information last reviewed: June 2009	Please foward any enquiries about this document to  haggars@waikatodhb.govt.nz
Next review date: July 2010	For Palliative Care advice, please call 8691 or the specialist on-call.

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