THE RELATIONSHIP BETWEEN THE USE OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND COUGH

Abstract

Angiotensin-converting enzyme inhibitors (ACEI) are a class of drugs used in various diseases, especially hypertension. Its mechanism is linked to the Renin-Angiotensin-Aldosterone system, in which it acts by competitively inhibiting the angiotensin-converting enzyme (ACE). Among its adverse effects, there is dry cough, which is the main cause of treatment abandonment. Cough is not directly justified, but the most accepted theory is that ACE inhibition causes accumulation of bradykinin and substance P in the respiratory tract, as ACE is responsible for degrading them, and this directly stimulates coughing and breathing reflexes and contraction of airway smooth muscle. The main risk factors found are female sex, smoking and use of thiazides associated with treatment. East Asian patients are also at increased risk. Genetic factors have been shown to be associated with the risk of coughing. The use of statins proved to be inconclusive, as one of the studies addressed indicated it as a protective factor, while the other literature indicated the opposite. A complete approach to coughing is essential before indicating the disuse of ACEI, as other factors, such as heart failure, can be true causes of the development of cough. As a way of combating the symptom, the temporary interruption of use appears to be possibly effective, since some of the patients do not have a cough on the return of treatment. Associated use of calcium channel inhibitors proved to be efficient in fighting cough, due to the inhibition of the propagation of the cough reflex.