Real World Effectiveness and Tolerability of low-dose opiates for Refractory/Unexplained Chronic Cough (RCC/UCC) in a tertiary clinic

Abstract

<b>Background:</b> Low-dose opiates are an off-license but effective treatment of RCC/UCC. Little is known about their real-world long term effectiveness and tolerability in RCC/UCC. <b>Methods:</b> We assessed tolerability and patient reported effectiveness of opiate therapy using a verbal cough severity score (VSS) on a 0-10 scale (0=no cough and 10=worst possible cough) in all RCC/UCC patients who trialled it as an antitussive in our tertiary outpatient clinic (Sept 2021-Jan 2022). <b>Results:</b> 100 patients prescribed opiate therapy for their cough were identified. Median (IQR) age was 64(55-73) years, 70(70%) were female and prescription duration was 52(12-104) weeks.&nbsp;In 36(36%) patients there was associated airways disease/GORD/nasal disease (RCC), 60(60%) had unexplained symptoms (UCC). The remaining had interstitial lung disease (n=4). Modified release MST 5mg bd was used most frequently (72%) (max dose 10mg bd), others included oxycodone and combined oxycodone/naloxone. Median pre-treatment VSS was 8/10.&nbsp;Median (range) drop of VSS was 4(0-10). 60(60%) reported a good-excellent response (median drop in VSS 5); 25(25%) had no response. Side-effects occurred in 38(38%) but were mild and managed with either dose reduction or constipation management in 23. The commonest side effect was constipation (25%), 15(15%) stopped low-dose opiates due to intolerable side effects. <b>Conclusions:</b> Unlicensed, low dose opiates improve patient reported outcomes and are well tolerated in the majority of patients with RCC/UCC.&nbsp;The commonest side-effect is constipation which can be well managed in most cases allowing patients to continue therapy.