Chemotherapy, a common cancer treatment, can lead to a cough. This symptom can arise from various factors related to the therapy or the patient’s compromised health. Understanding its origins helps in appropriate management.
Direct Chemotherapy-Related Cough
Chemotherapy can directly induce a cough through its effects on lung tissue. Certain chemotherapy drugs can cause lung toxicity, leading to conditions such as pneumonitis or pulmonary fibrosis. Pneumonitis is an inflammation of the lung tissue, often presenting as a dry cough, shortness of breath, and sometimes a low-grade fever. This inflammation can develop weeks to months after treatment begins.
Pulmonary fibrosis involves scarring of the lung tissue, which makes the lungs stiff and reduces their ability to exchange oxygen. A persistent dry cough is a common symptom of pulmonary fibrosis, and it can worsen as the scarring increases. Chemotherapy agents like bleomycin, methotrexate, cyclophosphamide, busulfan, and gemcitabine are associated with these lung toxicities. The risk depends on the specific drug, total cumulative dose, and any concurrent radiation therapy to the chest.
Other Cough Triggers During Chemotherapy
Beyond direct drug effects, individuals undergoing chemotherapy are susceptible to other cough triggers due to their weakened immune systems. Chemotherapy often causes neutropenia, a reduction in infection-fighting white blood cells, increasing the risk of bacterial, viral, and fungal infections. These opportunistic infections, which can affect the respiratory tract, frequently present with a cough, fever, and fatigue.
Gastroesophageal reflux disease (GERD) can also be exacerbated during chemotherapy, leading to a cough. Stomach acid refluxing into the esophagus and airway can irritate the throat, triggering a chronic cough, especially when lying down or after eating certain foods. Some chemotherapy drugs can contribute to fluid retention, leading to fluid buildup around the lungs (pleural effusion) or in the heart (pericardial effusion), causing shortness of breath and a cough. Pre-existing lung conditions or environmental irritants like smoke or allergens can also contribute to coughing.
When to Seek Medical Care
Contact the healthcare team if a cough develops or changes during chemotherapy. Persistent cough, especially if accompanied by a fever of 100.4°F (38°C) or higher, chills, or difficulty breathing, requires immediate medical attention. Other concerning symptoms include chest pain, coughing up blood, or any worsening cough that interferes with daily activities or sleep.
A sudden onset of shortness of breath or blue-tinged lips, nails, or skin also requires urgent evaluation. Avoid self-diagnosing the cause of a cough; consult your medical team promptly. The healthcare provider can assess symptoms, conduct necessary tests, and determine the underlying cause to guide treatment.
Approaches to Cough Management
Managing a cough during chemotherapy involves addressing its underlying cause, always in discussion with a doctor. Staying well-hydrated by drinking plenty of fluids can help soothe the throat and thin mucus. Using a humidifier can add moisture to the air, which may relieve a dry, irritated cough. Sucking on lozenges or hard candies can also provide temporary relief by moistening the throat.
Avoiding environmental irritants like smoke, strong perfumes, and allergens is beneficial. Depending on the cause, medical interventions may be considered. If an infection is identified, antibiotics or antiviral medications may be prescribed. For GERD, antacids or other medications to reduce stomach acid can help.
In cases of lung inflammation or scarring, corticosteroids might be used to reduce swelling. Cough suppressants or expectorants may be prescribed for symptomatic relief, but these are always used under medical guidance.