Cough

A cough is a natural reaction of the body to irritants in the airway. There are many possible causes of a cough: the common cold or flu, asthma, allergies, lung infections, smoke, or other pollutants. In cancer patients, a cough may also be a sign that the cancer has spread, or metastasized, to the lungs or their lining (pleura).

What is a cough?

A cough is a sudden, violent expulsion of air from the chest in response to an irritation in the airway. Coughing is an important way to keep your throat and airways clear. However, excessive coughing may mean you have an underlying disease or disorder.

What causes a cough?

Besides “the common cold” and flu, other common causes of coughs include:

• Asthma                                                                 
• Gastric reflux or heartburn
• Allergies (hay fever)
• Pneumonia (lung infection)
• Bronchitis (lung infection)
• Pollutants
• Emphysema (obstructive lung disease)
• Smoking cigarettes or exposure to second-hand smoke
• Lung cancer or metastases (cancer spread to lungs)               

How is a cough managed?

A cough is managed by treating the underlying cause.  For example:

• If the cause is allergies, you may be prescribed a daily allergy medication, such as:
  • Allegra^® (fexofenadine)
  • Alavert^®, Claritin^® (loratadine)
  • Zyrtec^® (cetirizine)
• If the cause is asthma, you may be prescribed an inhaler to help open your airway and reduce airway inflammation, such as:
  • Atrovent^® (ipratropium bromide) oral inhalation
  • Ventolin^® inhaler, Proventil^® inhaler (albuterol inhaler)
  • Advair^® (fluticasone and salmeterol oral inhalation)
• Lung infections, such as pneumonia or bronchitis, are usually treated with an antibiotic, such as penicillin or amoxicillin.
• For patients with gastric reflux or heartburn, an over-the counter antacid may be recommended, such as Maalox, Mylanta (aluminum and magnesium hydroxide), or Rolaids or Tums (calcium carbonate). Or an H2 blocker may be prescribed. These medications decrease gastric acid secretion in the stomach. Some H2 blockers are  Tagamet^® (cimetidine),  Pepcid, Axid^® (nizatidine), or Zantac. Another group of drugs that are even stronger inhibitors of gastric acid secretion are proton pump inhibitors (PPI). Some PPI’s are Prilosec^® (omeprazole), Prevacid (lansoprazole), and Nexium^® (esomeprazole magnesium).

Why is it important to carefully monitor a cough in cancer patients?

If you have a cough, your doctor may carefully monitor you for signs of lung metastases. Metastasis is the spread of cancer from its original location to distant sites in the body. Common locations for metastases include the bones, liver,and lungs. Cancers that spread to the lungs include breast cancer, prostate cancer, gastrointestinal tumors, kidney cancer, melanoma, sarcomas, lymphomas and leukemias, germ cell tumors, and rarely ovarian cancer. A cough with bloody sputum, which is the expectoration or spitting up of blood or bloody mucus from the lungs, throat or mouth, may be a sign of lung metastases. A new or persistent cough should be reported to your doctor.