Cough in palliative care

There are many causes that can contribute to a cough if you have a terminal illness. It may come and go quickly (acute) or may come on slowly and last for a longer time (chronic). Your cough may also have associated symptoms such as shortness of breath, wheeze or chest tightness. 

It can be caused by the terminal illness you are living with, eg, lung cancer, or other medical conditions that happen at the same time. It can also be caused by a combination of possible causes. Sometimes, it's not possible to find out an exact cause. 

Common causes of a cough in people living with a terminal illness include:

• cancer and its complications, such as pulmonary oedema, pulmonary embolism, pleural effusion or airway obstruction
• conditions affecting your lungs, such as asthma, COPD or interstitial lung disease
• heart conditions such as heart failure
• GI conditions such as gastro-oesophageal reflux
• infection such as pneumonia, common cold or bronchiectasis
• side effect of medicines or treatment, eg, if you are on ACE inhibitor or radiotherapy. 

Your doctor may ask you some questions to find out the possible causes of your cough. These include the following:

• Did it start suddenly or develop over time? Did anything trigger it? How long has it lasted?
• When do you cough? Is it worse at night?
• Are you breathless even when you're not coughing? Have you got any pain in your chest?
• Are you coughing up phlegm (mucus)? What colour is it? Is there any blood?
• Do you feel ill? Do you have a high temperature (fever), weight loss or sweats?
• Have you been in contact with anyone with tuberculosis (TB) or travelled overseas recently?
• Do you smoke?
• Have you started any new medicine recently?
• Do you have any pre-existing lung conditions such as COPD or asthma?
• Is there anything that you have found helps with your cough?

They may also listen to your chest, take a sample of any mucus you might be coughing up or order an x-ray or test to see how well your lungs work.

In palliative care, treatment aims to relieve your cough and make you feel better. You may have many healthcare professionals such as doctors, nurses, a physiotherapist, an occupational therapist, a palliative care specialist or a cancer specialist involved in your care, as it requires treatment from a multidisciplinary team. 

If you have a medical condition, or any obvious causes of your cough are found, treatment will focus on the condition or cause. 

The treatment of cough also depends on whether it is a dry or moist cough.

Dry cough (unproductive cough)

Some of the medicines that may be used to treat dry cough include:

• nebulised saline
• codeine
• morphine 
• steroids. 

Moist cough (productive cough)

Treatment for a moist cough may include:

• chest physiotherapy
• nebulised saline
• bronchodilators such as salbutamol or ipratropium
• steroids
• antibiotics if infection is suspected
• proton pump inhibitors such as omeprazole for reflux.

Nearing the end of life, some of these medicines may be given to you via subcutaneous injection (under your skin) or a syringe driver. Read more about syringe drivers. 

You may receive both non-medicine and medicine treatment together, depending on your condition.

You may also be referred to a chest physiotherapist, an occupational therapist, a psychologist, or a complementary therapist as part of your treatment. Sometimes, non-medicine measures may be useful, such as position changes (especially overnight), or sips of warm fluids may be soothing for a persistent cough.

Living with a cough can be frustrating. It can also make it challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need. 

If you need extra help in daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you. 

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society, NZ
How we can help(external link) Cancer Society, NZ
Cancer services – find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups