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PHYSICAL SYMPTOMS I‐RESPIRATORY and CENTRAL NERVOUS SYSTEM

Cough occurs in about one-third of patients with advanced cancer and in 80% of those with lung cancer. It may be caused by primary or secondary involvement of the lung with tumour, secondary infection, concurrent disease, such as chronic obstructive lung disease, asthma or bronchiectasis or by smoking. Cough may be dry and irritant or productive; dry cough is much more irritant and difficult to relieve. A search must be made for a removable cause. Bronchospasm requires bronchodilators by mouth or inhalation and an infection may require antibiotics. (Chloramphenicol is worth considering where antibiotics are prescribed; it is an excellent antibiotic which is rarely used in non-malignant patients because of exaggerated fears of bone marrow suppression and it can be very useful in palliative care.) The underlying cancer may need treatment with steroids, chemo or radiotherapy, and physiotherapy and postural drainage should be considered. Dry cough may respond to humidification of the atmosphere with nebulized water to which salbutamol may be added if there is associated bronchospasm. Mucolytic drugs, such as acetylcysteine or carbocysteine, of little value in treating non-malignant cough, may help where viscid sputum makes expectoration difficult. Cough medicines may help though most are little more effective than steam or cough sweets, which keep the upper respiratory tract moist. If a dry cough is exhausting then the use of linctuses of codeine, morphine or diamorphine may be indicated (see Table 1).