Cough

Coughing can be a distressing symptom and can be persistent, dry or productive. Breathlessness can trigger a cough, and vice versa. Persistent coughing can often cause vomiting, exhaustion, chest or abdominal pain and insomnia.

Causes

Coughing is a normal mechanism that protects the airways and lungs and is under both voluntary and involuntary control.

Coughing can be caused by inflammation, irritation or excessive secretions. It can be caused by the lung cancer irritating the airways, or secreting fluids; however there are other causes such as chest infection.

Management

It is important you discuss any cough symptoms with your doctor or nurse, to enable a full assessment of the cough and the effect it has on you. Management will be determined by the nature of the cough, as well as your general condition.

Strategies that help a productive cough

• Drink plenty of fluids as this will help to thin the secretions; water, juices or canned drinks are preferable. Caffeine based tea, coffee and cola are less helpful as they make you pass more urine.
• Ensure you are in a comfortable sitting position, e.g. relaxed sitting, relaxed standing, forward leaning or lying on your side with your good side facing upwards.
• A physiotherapist can advise you on certain types of breathing techniques that may be helpful.
• Some patients find benefit using: steam inhalation, nebulised saline, cough mixtures for productive coughs, physiotherapy to the chest and/or medication to reduce the stickiness of the sputum.

Strategies that help a dry cough

• Try to increase your oral intake of fluid, preferably with water.
• Suck on sweets or lozenges.
• Drink warm honey and water.
• Try ice cold drinks or suck on ice pops.
• Try breathing in steam from hot water; you could also try some herbal drops in the water.
• For a night time cough, avoid lying on your back.
• If you have trouble bringing up phlegm up your doctor may be able to prescribe medication to help i.e. Carbocisteine.

Hoarseness of Voice

Some people with lung cancer can present with or develop a hoarse voice. This can be an irritating symptom; it can be very tiring to talk, as it takes a lot of effort to be heard and understood, particularly over the phone.

Causes

Often this is not a serious problem and may be caused by compression of the tumour on a nerve in the chest called the laryngeal nerve. If this nerve is squashed one of the vocal cords in your throat can become paralysed, leading to a hoarse voice.

If the vocal cord is not working properly, patients may also find it more difficult to swallow effectively and there is a risk that food and drink could be inhaled into the lungs.

Occasionally a hoarse voice may be caused by oral thrush (Candida).

Management

The hoarseness of voice should be fully assessed by member of your lung cancer team.

If there is any infection in the mouth, this should be treated first.

Sometimes if the tumour reduces in size, the pressure on the nerve may be released. Therefore treatments such as steroids, radiotherapy and chemotherapy can be used if appropriate.

In some cases, it may be useful to ask for an assessment by the ear, nose and throat team. This is to see if an intervention, such as vocal cord injections, would be helpful.

Referral to the speech and language therapy team may be needed to assess the swallowing.

Coughing up of Blood (Haemoptysis)

Haemoptysis is the coughing up of blood originating from the respiratory tract. This is a symptom that can occur in someone who has lung cancer, and can be very distressing to patients and carers. Up to one third of patients with lung cancer develop haemoptysis.

Causes

It is important to establish that the blood or blood stained material has come from the chest and not the nose, upper respiratory tract, or gastrointestinal tract.

Haemoptysis is caused by the cancer invading a blood vessel in the lungs, causing it to bleed. However other causes are infection, clot on the lung, or blood clotting disorders.

Coughing of blood can be short-lived or persistent and rarely causes a major problem.

Management

Ensure your doctor is aware and assessed the cause and severity of the bleeding.

Sometimes a drug can be used to cause the blood to clot quicker such as Tranexamic acid.

Radiotherapy or laser therapy to the chest area can be very effective in sealing the bleeding blood vessel.