Analysis of the causes and prevention of chronic cough after lung cancer surgery

  Lung cancer has now become the most prevalent malignant tumor in China, and among the growing number of lung cancer patients year by year, a significant proportion of them need to undergo surgical treatment, either radical resection for long-term cure or palliative tumor reduction to improve the quality of survival. However, after lung cancer surgery, many patients often face a troublesome problem: chronic postoperative cough. This symptom is characterized by an irritating dry cough with intermittent episodes, which may be accompanied by a small amount of white sputum and may decrease with time after surgery, or persist and persist; some female or fat patients may also have wheezing and sweating, which is often aggravated by changes in position (often from upright to lying down) or climate change.  We know that a normal cough is a protective respiratory reflex to remove secretions or foreign bodies from the respiratory tract. However, if this protective response lasts for more than 8 weeks and seriously affects the quality of life of patients after lung cancer surgery, it is called postoperative chronic cough. The persistence of this symptom can affect rest, consume energy, interfere with normal speech communication, and in severe cases, it can lead to capillary rupture in the upper respiratory tract and secondary hemoptysis, and sometimes even be mistaken for tumor recurrence, which seriously reduces patients’ postoperative quality of life.  After following up the survival of a large number of postoperative lung cancer patients, and after excluding the factors of lung cancer recurrence, we analyze the common causes of chronic cough after lung cancer surgery as the following: 1. Damage to lung tissues including bronchi, alveoli, nerves and some glands caused by surgery, followed by local chronic inflammatory changes, as well as stimulation of foreign bodies such as scar formed after surgery and sutures in the airway, are the causes of The most common cause of postoperative chronic cough.  2. Physical changes in the airway after surgery (e.g., torsion), resulting in increased airway reactivity.  3, Pleurisy or pleural adhesions resulting from open-heart surgery can also cause long-term chronic cough.  4. Medium to large pleural effusions, resulting in intra-thoracic inflammatory irritation or compression, can also cause a persistent cough.  The presence of this symptom often leads to a misunderstanding in treatment: some patients often blame it on “inflammation of the respiratory tract” etc. when the cause of persistent cough is not clear, and therefore take a lot of antibiotics for a long time in order to relieve the symptoms, which is not only ineffective but also leads to antibiotic abuse. Therefore, the correct approach should focus on two main aspects: active prevention and symptom relief.  Since this chronic cough arises as a result of the damage caused by surgery and the ongoing effects of its subsequent effects, the first step is to raise awareness among thoracic surgeons and to take active preventive measures during surgical treatment in order to reduce trauma and promote healing. For example, it is important to follow the natural structure of the tissues as much as possible when cutting and separating them, and to reduce the rough cuts of the electric knife; to use absorbable sutures as much as possible when suturing (anastomosing) the airway to reduce foreign body irritation; and to improve intraoperative hemostasis to reduce thoracic adhesions. In addition, it is necessary for clinicians to closely observe and follow up patients after surgery, so that postoperative pulmonary reopening insufficiency or pleural effusion can be detected and properly treated in time, which can reduce a lot of avoidable pain of patients.  Of course, due to the established damage caused by the surgery itself, patients need to understand that it is unrealistic for the chronic cough to disappear completely after surgery, and therefore several methods to relieve the cough are systematically introduced here: i. Appropriate application of cough suppressants. Such as kojic syrup, cough syrup for colds and winds, and licorice combination, etc. Their effects are mainly cough suppressant, taking into account phlegmification, and have a certain sedative effect, and are suitable for those with dry and itchy throat, coughing at night, and affecting sleep. Diabetic patients should not take syrup, but can be given appropriate amount of cough capsules or tablets, such as white glucose cough tablets, etc.  Second, Chinese herbal medicine treatment. Traditional Chinese medicine classifies cough into hot cough, cold cough, windy cough and internal cough, etc. Traditional Chinese medicine practitioners will prescribe the right medicine according to the patient’s specific postoperative condition and choose specific medicinal preparations below. Commonly used herbal medicines to relieve cough include snake gall bladder and Sichuan shellfish liquid, Sichuan shellfish cough relief lotion, powerful loquat lotion, fresh bamboo leech, etc. It should be emphasized that these need to be applied under the guidance of a regular Chinese medicine practitioner, depending on the individual.  Third, the regulation of food. Ensure a balanced intake of food and eat more foods that nourish Yin and moisten the lungs appropriately, such as almonds, lilies, water chestnuts, lotus seeds, duck pears, yams and barley, etc. Avoid smoking, alcohol and spicy foods. Fourth, maintenance and environment. Pay attention to adequate rest and strengthen physical exercise appropriately to improve immune function; keep indoor air moist, and respiratory fumigation or fogging can be carried out regularly when conditions are available; go to suburban fields more often when the temperature is suitable to increase the exposure to quality air environment; actively maintain a healthy mentality.  It is believed that through the above measures, the condition of chronic cough after lung cancer surgery will be greatly improved. It is sincerely hoped that the majority of lung cancer patients can continue their beautiful life after getting rid of the tumor.