The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough

Abstract

Introduction Why do only some of patients who are prescribed angiotensin converting enzyme inhibitors (ACE‐I) develop cough? The pathogenesis of ACE‐I‐induced cough remains controversial and requires further studies. Objective We aim to investigate whether asthma is a contributing cause of ACE‐I‐induced cough. Methods Patients attending a cardiology clinic between March 2016 and March 2017 who were diagnosed with ACE‐I induced cough were included in this study. ACE‐I‐induced cough was defined as cough which developed within 4 weeks after initiation of ACE‐I therapy and which improved within 4 weeks after discontinuation of the ACE‐I. Patients who had received ACE‐I treatment for at least 6 months without side effects were included in the study as a control group. Face‐to‐face questionnaires, pulmonary function tests (PFT) and skin prick tests were applied to all the patients. If there was discordance between asthma history and PFT results, a methacholine bronchial provocation test (BPT) was performed. Results A total of 43 patients with ACE‐I induce cough were compared with 50 controls. Bronchial hyperreactivity (BHR), rhinitis, atopy and family history of asthma were more frequent in patients with ACE‐I induced cough (P < .001). Patients with ACE‐I‐induced cough had significantly higher incidence of diagnosed asthma [OR = 8.28 (95%CI: 3.26‐21.03) P < .001]. Conclusions Asthma and an atopic background constitute a substantial risk factor for ACE‐I induced cough. The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough. However, the fact that most asthma patients tolerate ACE‐I therapy, indicates that other cofactors are likely involved.

Association between angiotensin-converting enzyme inhibitors and the risk of lung cancer: a systematic review and meta-analysis

“…Notably, respiratory adverse effects have persisted as nuisance adverse events with the use of ACEIs [3], of which dry cough is a major complication [4]. Some studies have suggested that the use of ACEIs is associated significantly with the risk of airway obstructive symptoms and a worsening risk of bronchoconstriction or asthma [5,6]. Preclinical carcinogenicity animal studies have shown negative results; however, some studies have reported that ACEIs participate in cellular proliferation, angiogenesis and tumour progression [7,8].…”

Angiotensin-Converting Enzyme and Hypertension: A Systemic Analysis of Various ACE Inhibitors, Their Side Effects, and Bioactive Peptides as a Putative Therapy for Hypertension

“…Some studies have shown that taking ACEIs increases the risk of airway obstruction symptoms and makes the risk of bronchial asthma or asthma worse [56,57]. Animal studies on carcinogenicity have shown negative results, but some studies have found that ACEIs are involved in angiogenesis, cell proliferation, and the growth of tumours [58,59]. Recent research suggests that patients taking ACEIs may develop lung cancer [60][61][62].…”