Asthma and ACE-I

Q: Asthma patients are more prone to get cough from Angiotensin Converting Enzyme inhibitor (ACE-I).

A) True

B) False

Answer: B

Patients with asthma are not at high risk of developing additional cough, but they may experience increased bronchospasm, so it's still a watchful situation!

A dry hacking cough associated with ACE-I therapy remained an enigma for clinicians. For some reason, females are affected more. It resolves with discontinuation but may recur when challenged with the same ACE-I or a different name. A genetic component is highly suspected.

Interestingly, nonsteroidal antiinflammatory drugs (NSAIDs) and aspirin have shown to decrease or improve the tendency of cough due to ACE-I, but they come with the risk of hyperkalemia, particularly in patients with renal insufficiency.

#pharmacology

#toxicology

#pulmonary

References:

1. Wood R. Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study. Br J Clin Pharmacol 1995; 39:265.

2. Lunde H, Hedner T, Samuelsson O, et al. Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors. BMJ 1994; 308:18.

3. Tenenbaum A, Grossman E, Shemesh J, et al. Intermediate but not low doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough. Am J Hypertens 2000; 13:776.

4. Ghouse J, Tragante V, Muhammad A, et al. Polygenic risk score for ACE-inhibitor-associated cough based on the discovery of new genetic loci. Eur Heart J 2022; 43:4707.