Clinical Profile of Refractory Chronic Cough with Somatic Symptom Disorder: Greater Symptom Burden and Poorer Treatment Response

Objective This study aimed to investigate the clinical characteristics, cough severity, and psychosocial function differences in patients with refractory or unexplained chronic cough (RUCC) comorbid with somatic symptom disorder (SSD). It preliminarily analyzes the comorbidity features to provide a theoretical basis for comprehensive clinical diagnosis and treatment. Methods RUCC patients treated at the Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University, were prospectively enrolled from January 2024 to March 2025. The SSD-12 questionnaire was administered to all participants, and a score greater than 16 was used to define the SSD-positive (SSD+) group; all others were classified as SSD-negative (SSD–). Cough severity and quality of life were assessed using the Cough Visual Analog Scale (VAS), Cough Symptom Score, and Leicester Cough Questionnaire (LCQ). Psychological status was evaluated using the PHQ-9 and GAD-7 scales. Patients were followed up for at least 8 weeks to compare treatment responses. Results Among the cohort of 171 patients with refractory chronic cough (RUCC), 70 (40.9%) were identified as having comorbid somatic symptom disorder (SSD+). The SSD + group had significantly higher baseline VAS scores (79.0 (62.0–89.3) vs. 61.0 (41.0–80.0), P < 0.001) and daytime cough symptom scores (3.0 (2.0–4.0) vs. 3.0 (2.0–3.0), P = 0.013) than the SSD– group, and significantly lower LCQ total scores (10.40 (8.44–12.32) vs. 14.00 (11.50–16.29), P < 0.001). The SSD + group also had significantly higher anxiety (GAD-7: 7.46 ± 4.78 vs. 2.20 ± 2.79, P < 0.001) and depression scores (PHQ-9: 7.17 ± 5.09 vs. 2.25 ± 2.80, P < 0.001). Higher baseline psychological scores in the SSD + group were associated with smaller reductions in cough VAS scores after treatment. Conclusion SSD may be associated with more severe cough symptoms, psychological distress, and reduced quality of life in RUCC patients. RUCC patients comorbid with SSD may be more difficult to treat. Trial registration Chinese Clinical Trials Register (http//www.chictr.org.cn/, ChiCTR2400079808). Registered January 12, 2024.