Let’s discuss cough, stridor and hemoptysis.
Patients of end stage lung diseases like COPD, interstitial lung disease and lung cancer can suffer from chronic cough due to various reasons.
Most common being the stretch of the lung receptors due to the disease itself, others can be chronic infections, fluid overload, psychological reasons, many times the lung cancer mass or the lung metastasis can itself stimulate cough.
Treatment includes various home remedies like use of honey, handheld fan or psychological suppression of cough.
Various antitussives that are cough suppressing agents like your dextromethorphan, benzonatate.
Codeine is available for this; others like morphine, benzodiazepines, gabapentin can be used for this kind of cough.
Stridor is a condition where a very noisy breathing comes in inspiration from the trachea.
It happens if a mass is present in the trachea or there is a mass which is compressing the tracheal area from outside or there is a laryngeal edema. Whenever a patient is suffering from it is important to take care of the airway immediately it can be taken care of by intubating the patient or by performing a tracheostomy.
One solution would be to take care of the mass itself which can be done by various interventional Pulmonology procedures.
Having said that, it is important that the management at this point of time has been discussed with the patient and their relatives because most of these patients are at the end stage of their disease and the treatment that we are performing is only going to be palliative.
Let’s talk about hemoptysis. This can be caused by lung mass itself which is bleeding.
It can be an angiogenic tumour or the patient can have low platelets due to bone marrow invasion of the cancer itself or because of chemotherapy. Other conditions like if the patient is already on some anticoagulation or sometimes chemotherapy can lead to bleeding.
It’s important that there are reversible conditions that are taken care of.
Endobronchial lesions can be stopped to bleed by embolisation or Argon plasma coagulation again.
These are some interventional Pulmonology procedures that can be performed.
It is important to establish the airway so in case of massive hemoptysis.
It is important that the diseased lung is kept in a dependent position. Patient is intubated timely.
Again, having said all this, it is important that palliative care as a plan is made with the patient and the caregiver, and accordingly the situation is managed.