Innovative Tools and Perspectives in Cough Management: Cancer and Cough

Cough is a prevalent symptom in lung cancer that impairs quality of life. Postoperative cough after pulmonary resection (CAP) has an incidence of approximately 21.1%-55.8%. CAP tends to peak around 1-month post-surgery, and often improves by 3 months. Risk factors for persistent CAP include female sex, extensive resection (e.g., lobectomy or lymph node dissection), and postoperative gastroesophageal reflux. Pulmonary rehabilitation programs significantly reduce postoperative cough incidence and improve cough-specific quality of life. In patients with lung cancer, cough occurs in over 50% of cases, regardless of stage or histology. A stepwise management algorithm is recommended: first treat the cancer and any contributing comorbidities, then use simple demulcents to soothe airways. If needed, add centrally acting antitussives such as codeine or dextromethorphan, followed by peripherally acting agents (e.g., levodropropizine, benzonatate, or levocloperastine). In refractory cases, the neurokinin- 1 (NK1) receptor antagonist aprepitant reduced cough frequency in a randomized trial. Substance P, which activates NK1 receptors in vagal sensory pathways, appears to drive cough; aprepitant blocks this activation in preclinical models. Cough is a common and burdensome symptom in lung cancer, whether post-surgical or disease-related. This narrative review outlines a stepwise approach to evaluation and treatment, starting with cancer-directed therapy and supportive care, followed by evidence-backed antitussives. Emerging therapies like NK1 receptor antagonists show promise for refractory cases. High-quality trials are needed to further validate these approaches and integrate them into standard care to improve the quality of life of patients with lung cancer.