GPAtlas🧭 When to suspect
Cough is one of the most common and exhausting symptoms in advanced illness, reported as very distressing by around a quarter of people in their last year of life.
• Cough may be dry and non-productive, productive of sputum, or barking.
• Where there is recurrent laryngeal nerve involvement, it may be a prolonged, low, bovine cough.
• The character of the cough, and whether the patient can still clear secretions effectively, determine the entire management strategy.
Cough is rarely a symptom in isolation.
• Look for the underlying cause – lung cancer or metastases, malignant pleural effusion, heart failure, or end-stage respiratory disease.
• Look for treatable contributors such as chest infection, gastro-oesophageal reflux disease (GORD), bronchospasm, or an angiotensin-converting enzyme (ACE) inhibitor.
• Treatment-related causes (chemotherapy, radiotherapy-induced pneumonitis) and aspiration should also be considered.
• Coughing itself can cause muscle and rib pain, vomiting, syncope, urinary incontinence and broken sleep.
| Cough type | Primary aim | First-line approach |
|---|---|---|
| Dry/non-productive | Suppress the cough | Demulcent, then antitussive ladder (simple linctus → low-dose morphine) |
| Productive, effective cough | Help clear secretions | • Nebulised 0.9% saline, physiotherapy, carbocisteine • Avoid suppressing |
| Productive, dying & too weak to clear | Dry secretions for comfort | Reposition + antimuscarinic (e.g. hyoscine butylbromide) |
Source: Scottish Palliative Care Guidelines · Association for Palliative Medicine
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.