Background

Refractory chronic cough (RCC) is a common and challenging clinical problem. Treatment strategies based upon the current international cough management guidelines are limited.

Aim

To evaluate the efficacy of subcutaneous Octreotide in patients with refractory chronic cough.

Methods

Patients in this retrospective case series attended the Hull cough clinic and were initiated on Octreotide in a nurse led clinic from June 2019 to December 2022. Follow up details and treatment outcomes were categorized.

Results

Twenty-one patients (20 females; mean age: 61 ± 13 years; mean body mass index: 30 ± 6; mean cough duration: 14 ± 12 years; mean Hull Airways Reflux Questionnaire (HARQ) 47 ± 15 (upper limit of normal 14) were initiated on 50mcg Octreotide subcutaneous injections and the dosage adjusted as necessary. Over 50% of patients with RCC who had previously failed our usual treatment strategies successfully responded to Octreotide subcutaneous injections. The HARQ scores fell from 47 ± 15 to 23 ± 15 (p = 0.005) and Symptom Assessment Score fell from 32 ± 10 to 15 ± 11 (p = 0.001) in four months. Of the 16 patients who had High Resolution Oesophageal Manometry within their routine care, oesophageal dysmotility was diagnosed in 13 of them. 

Conclusion

Octreotide (a samatostatin analogue) as a treatment for RCC may be burdensome, painful, and associated with adverse effects.  However, in patients with intractable RCC it is a treatment option in the absence of any other currently available therapy. A randomized placebo-controlled trial should be conducted to confirm or refute our findings in this disease with distressing morbidity.