Treatments for potential causes of cough such as a PPI or inhaled steroid can take 6-8 weeks to take effect.
If lung malignancy is felt to be the primary cause of cough, consider treatment such as radiation therapy or chemotherapy.
Pholcodine linctus (Duro-tuss™) – this is an antitussive and does NOT contain codeine phosphate. Dose: 10-15 ml up to four times daily.
Morphine elixir – low dose regularly or PRN.
Steroids – either prednisone 20-40 mg mane, or dexamethasone 8-12 mg mane – aim to reduce gradually to lowest effective dose.
Nebulised local anaesthetic e.g. lignocaine 2%, 5 ml q6h – WARNING: No food or fluid for 1 hour due to aspiration risk.
Bronchospasm is a recognised side-effect. In fit patients consider spirometry pre- and post-nebulised lignocaine to assess for bronchospasm (drop in FEV1 of 200 mLs and 12%).
Patients on high flows of oxygen (>4 litres/minute via nasal cannulae) may benefit from humidified oxygen. Please discuss this with the oxygen provider (CRISS Service) who can advise if this is appropriate.
Chest physiotherapy, including techniques such as Active Cycle of Breathing (ACBT).
Ipratropium (Univent™) or DuolinSalbutamol (Asthalin™) nebulisers.
Oral steroids if bronchoconstriction is suspected.
Trial of antibiotics may be appropriate if infection is suspected.
Anticholinergic medications are generally avoided, since drying of secretions may make them more difficult to expectorate.