ACE Inhibitor-induced cough and bronchospasm : Incidence, mechanism and management.
A dry, tickly and often bothersome cough is the most common adverse effect of ACE inhibitors.
Recent studies indicate that cough may develop in around 10% of the patients treated with ACE inhibitors.
In half of these patients, the ACE inhibitor has to be discontinued.
Cough has emerged as a class effect occurring with all ACE inhibitors with no clear difference between the single substances.
While ACE inhibition is safe in the vast majority of patients with obstructive airways disease, asthmatic symptoms or exacerbation of asthma as well as a rise in bronchial reactivity have been occasionally reported.
ACE inhibition increases the cough reflex.
The mechanisms underlying ACE inhibitor-induced cough are probably linked to suppression of kininase II activity, which may be followed by an accumulation of kinins, substance P and prostaglandins.
Physicians should be aware that a dry cough is the most common adverse effect of ACE inhibitors and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later.
Replacement by another ACE inhibitor should not be tried, since the cough will almost always recur on rechallenge with the same or another ACE inhibitor.
After withdrawal of the ACE inhibitor, which is the treatment of choice, cough will resolve usually within a few days.
Mots-clés Pascal : Antihypertenseur, Inhibiteur angiotensin converting enzyme, Toxicité, Bronchospasme, Toux, Homme, Mécanisme action, Traitement, Incidence, Epidémiologie, Article synthèse, Appareil respiratoire pathologie, Bronche pathologie, Trouble respiratoire
Mots-clés Pascal anglais : Antihypertensive agent, ACE inhibitor, Toxicity, Bronchospasm, Cough, Human, Mechanism of action, Treatment, Incidence, Epidemiology, Review, Respiratory disease, Bronchus disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0335080
Code Inist : 002B02U07. Création : 10/04/1997.