Cough and Chemotherapy

Cough and Chemotherapy

What is a cough and how is coughing related to chemotherapy?

Cough is a sudden, noisy and violent expulsion of air from the chest, caused by irritation in the air passages, or by the reflex action of a nervous or gastric disorder. Chronic and/or dry cough can be side effects of chemotherapy and other cancer treatments.

Causes of Cough:

• Allergies: Something in the environment (i.e. dust, smoke, ragweed, pollen, etc) or to a food or a medicine. In response to the allergy-causing agent, people get drainage (usually clear drainage) or a "runny nose." Red, itchy eyes may accompany this cough too. This drainage can run down the back of your throat and cause a "tickle" in your throat and can produce a chronic cough.  
• Infection: Many people cough when they get a cold, a viral or bacterial infection (i.e. pneumonia, tuberculosis), or the flu. This cough is usually accompanied by feeling tired, achy, running a fever, and/or having a runny/stuffy nose with clear or yellow/green mucous. 
• Irritants: Such as smoking, second hand smoke, chemical irritants.
• Disease: Tumors in the lung or lymph node involvement in the chest (called the mediastinum) can cause cough spells.
• Gastric reflux or heartburn: This kind of cough is usually aggravated by certain foods (i.e. chocolate, mints, alcohol, and coffee) or by smoking. The cough can also be worse when one lays down, especially lying down shortly after eating a meal. Lastly, being overweight can also aggravate these symptoms. Therefore, by losing some weight you may be able to lessen your heartburn.

Chronic Cough Symptom Management:

General: Cough is managed based on the underlying cause. Treatment of the cause may result in the elimination of the symptom.

Things you can do (the patient):

• Describe your cough the best you can to your doctor. Think about what kinds of things/activities aggravate or relieve your cough. Think about how long you have had your cough. Do you cough out mucous or blood with it? Do you have a fever?  Is it a dry cough? Chronic? Have you been losing weight suddenly without explanation? Do you get short of breath?
• Take your medications as prescribed. For example, people who suffer from allergies are usually prescribed a daily medication (i.e. Zyrtec®, Claritin®, or Allegra®) or people with asthma may be prescribed an inhaler (i.e. Atrovent®, Albuterol®, Advair®). If you are prescribed an antibiotic for an infection, take it as prescribed. Do not stop taking the antibiotic just because you feel better.
• If you suffer from heartburn, try to avoid foods that aggravate your symptoms (see symptom management - heartburn for further ideas)
• Quit smoking and avoid environmental/occupational exposure to irritants.
• You may try using a humidifier to keep your throat and nasal passages moist if you have a chronic, persistent dry cough.
• If it is okay with your doctor, you may try using cough drops or an over the counter preparation (see drug categories below).
• If you have a cold or a viral infection, try getting rest and plenty of fluids.
• If you suffer from allergies it is a good idea to vacuum and dust furniture weekly since dust can aggravate your symptoms. You may try reducing the humidity in your home to less than 50%. Also, use air conditioning instead of leaving the windows open so that outside irritants do not get inside your home.

Drugs That May Be Prescribed by Your Doctor for Cough:

Drugs that may be prescribed by your health care provider to minimize the effects of cough brought on by chemotherapy:

• Antitussive: (cough suppressant). Benzonatate, codeine, and dextromethorphan are generic ingredients of various cough preparations.
• Another common medication you may receive is Hydrocodone Bitartrate-Homatropine Methylbromide (Hycodan®). This is a narcotic antitussive (anti-cough medication), which will help relieve your cough.
• Expectorant: (aides in coughing up phlegm or mucous). Guaifenesin - a generic ingredient of various cough preparations.
• Decongestant / Alpha/Beta agonist: (acts on certain receptors of the lining of the lungs and airways causing constriction, and relaxation thus relieving congestion). Pseudoephedrine - a generic ingredient of various cough preparations.
• Antihistamines: (Competes with histamine for receptor sites on cells in the lining of the gastrointestinal tract, blood vessels, and nose, lung and airways, this helps to decrease symptoms of excessive secretions (ie. runny nose) particularly related to allergies). Brompheniramine, cetirizine, chlorpheniramine, diphenhydramine, fexofenadine, loratadine are generic ingredients of various cough preparations.

Cough due to gastroesophageal reflux disease (GERD):

• Antacid: Over-the-counter preparations, these contain the following compounds alone or in combination; calcium carbonate, aluminum hydroxide, magnesium hydroxide, magladrate. (Common names for these are Maalox®, Mylanta®, Rolaids®, or Tums®).
• H2 blockers: These medications compete with histamine at the H2 receptors on certain cells on the lining of the stomach and into the small intestine. This decreases gastric acid secretions. 
• A few examples of these drugs that may be prescribed include cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®), or ranitidine (Zantac®).
• Proton-pump inhibitor. These medications suppress gastric acid secretions by inhibiting the enzyme pump process, which is the final step in the production of gastric acid secretions. 
• Short term use to treat active ulcers.
• Examples include esomeprazole (Nexium®), lansopraxole (Prevacid®), omeprazole (Prilosec®), pantoprozole (Protonix®) or rabeprazole (Aciphex®).

When to Contact Your Doctor or Health Care Provider:

• If you are on chemotherapy and you develop a fever of 100.5F or higher call your healthcare provider immediately.
• Call your doctor whenever you have bothersome symptoms that are unrelieved by the medications he/she prescribed for you.
• Call your doctor if you have a bothersome reaction to a prescribed drug.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.