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Is ACE–inhibitors cough a difficult diagnosis? 1100 general practitioners replies from four countries

2016; Elsevier BV; Volume: 32; Linguagem: Inglês

10.1016/j.ejim.2016.03.021

1879-0828

Xavier Humbert, Sophie Fédrizzi, Joachim Alexandre, Paolo Emilio Puddu, Antoine Coquerel, Jean-Charles Robert, Lydia Guittet,

Asthma and respiratory diseases

Angiotensin-converting enzyme inhibitors (ACEI) are widely used in the management of hypertension, heart failure, myocardial infarction, renal failure, and kidney diseases. ACEI produced a 10% reduction in all-cause mortality and a 12% reduction in cardiovascular mortality in hypertensive patients [ [1] Ferrari R. Boersma E. The impact of ACE inhibition on all-cause and cardiovascular mortality in contemporary hypertension trials: a review. Expert Rev Cardiovasc Ther. 2013; 11: 705-717 Crossref PubMed Scopus (39) Google Scholar ]. They represent the first-line therapy in cardiovascular protection in the group of renin angiotensin aldosterone system (RAAS). Generally, they are well-tolerated by most patients. However, cough is a well-known side effect with this drug class, and the cough can be severe enough to require medication discontinuation. Cough is typically dry and nonproductive, usually with a sensation of "tickle" in the vicinity of the sterna notch, sometimes associated with "postnasal drainage" [ [2] Poole M.D. Postma D.S. Characterization of cough associated with angiotensin-converting enzyme inhibitors. Otolaryngol Head Neck Surg. 1991; 105: 714-716 PubMed Google Scholar ]. The cough presents a night dominance and is not dose-dependent [ [3] Israili Z.H. Hall W.D. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med. 1992; 117: 234-242 Crossref PubMed Scopus (888) Google Scholar ]. In a meta-analysis of clinical trials, the incidence of ACEI-induced cough has been reported to be 11.48% with enalapril but Bangalore et al. suggested that this side effect is underestimated [ [4] Bangalore S. Kumar S. Messerli F.H. Angiotensin-converting enzyme inhibitor associated cough: deceptive information from the Physicians' Desk Reference. Am J Med. 2010; 123: 1016-1030 Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar ]. Vegter et al. have previously shown that an excess of patients receive antitussives after ACEI initiation and suggested that cough is not recognized as a side-effect of ACEI [ [5] Vegter S. de Jong-van den Berg L.T.W. Misdiagnosis and mistreatment of a common side-effect–angiotensin-converting enzyme inhibitor-induced cough. Br J Clin Pharmacol. 2010; 69: 200-203 Crossref PubMed Scopus (44) Google Scholar ]. In light of these facts, we have examined these misdiagnosis and mistreatment of ACEI-induced cough.