Waikato DHB Palliative Care Guidelines

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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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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 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 (to dry secretions).

Oral steroids if bronchoconstriction is suspected.

Trial of antibiotics may be appropriate if infection suspected.

Consider sputum

•  infection
• bronchorrea
• haemoptysis

Information last reviewed: March 2012	Please foward any enquiries about this document to Sandra.Haggar@waikatodhb.health.nz
Next review date: March 2014	For Palliative Care advice, please call (07) 839 8691 or the specialist on-call.

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