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2017最新chest 指南:肺癌相关性咳嗽的治疗

时间:2017-09-22    点击: 次    来源:网络投稿    作者:网络投稿 - 小 + 大

1.   In adultpatients with cough associated with lung cancer that persists despite cancertreatment, we suggest, as a first step, that a comprehensive assessmentaccording to a published, evidence-based management guideline be undertaken toidentify any co-existing causes linked with cough and initiate treatment accordingly.

2.   In adult patients with lung cancer experiencing cough despite anticancer treatment, we suggest cough suppression exercises as alternative or additional to pharmacological therapy where such services are available.

3.   In adult patients with cough due to localized endobronchial disease for whom surgery, chemotherapy, or external beam radiation are not indicated, we suggest the use of endobronchial brachytherapy where such specialist facilities are available and in suitable patients.

4.   In adult patients with lung cancer who require a pharmacological approach for the treatment of cough, we suggest an initial trial with demulcents such as butamirate linctus (syrup) or simple linctus (syrup) or glycerin-based linctus (syrup) where available.

5.   In adult patients with lung cancer experiencing cough that does not respond to demulcents, we suggest pharmacological management using an opiate-derivative titrated to an acceptable side-effect profile.

6.   In adult patients with lung cancer experiencing opioid-resistant cough, we suggest a peripherally-acting antitussive (where available), such as levodropropizine, moguisteine, levocloperastine or sodium cromoglycate.

7.   In adult patients with lung cancer experiencing opioid-resistant cough that does not respond to peripheral antitussives, we suggest a trial with local anesthetics, including nebulized lidocaine/bupivacaine or benzonatate.

8.   In adult patients with intractable cough due to lung cancer in whom surgery, chemotherapy, external beam radiation, brachytherapy and the previously mentioned nonpharmacological and pharmacological approaches are ineffective or not indicated, we suggest that clinicians consider performing N-of-1 randomized controlled trials to determine if any of the following drugs might be of benefit in controlling cough because none have been definitively shown to be effective nor devoid of side effects: diazepam, gabapentin, carbamazepine, baclofen, amitriptyline, thalidomide.

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