Dry tickly cough that won't go away
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Persistent Dry Tickly Cough: Causes and Management
ACE Inhibitor-Induced Cough
Prevalence and Characteristics
A persistent dry, tickly cough is a well-documented adverse effect of angiotensin-converting enzyme (ACE) inhibitors. Studies indicate that this type of cough can develop in approximately 10-15% of patients treated with ACE inhibitors such as captopril, enalapril, lisinopril, ramipril, cilazipril, and quinipril . The cough is typically described as dry, nonproductive, and persistent, often starting within the first week of therapy and continuing as long as the medication is taken.
Mechanisms
The underlying mechanisms of ACE inhibitor-induced cough are linked to the suppression of kininase II activity. This suppression leads to the accumulation of kinins, substance P, and prostaglandins, which are believed to stimulate lung afferent C fibers and increase the cough reflex . The role of prostaglandins is further supported by anecdotal reports of cough resolution in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs).
Management of ACE Inhibitor-Induced Cough
Discontinuation and Alternatives
The primary management strategy for ACE inhibitor-induced cough is the discontinuation of the offending drug. In most cases, the cough resolves within a few days after stopping the medication . It is important to note that switching to another ACE inhibitor is not recommended, as the cough is likely to recur with any ACE inhibitor .
Monitoring and Awareness
Physicians should be vigilant in monitoring for the development of a dry cough in patients on ACE inhibitors, as this side effect can occur not only shortly after starting therapy but also months or even a year later . Recognizing this adverse effect early can prevent unnecessary discomfort and improve patient compliance with alternative treatments.
Conclusion
A persistent dry, tickly cough is a common and bothersome side effect of ACE inhibitors, affecting a significant proportion of patients. The cough is primarily due to the accumulation of kinins, substance P, and prostaglandins, which stimulate the cough reflex. Discontinuation of the ACE inhibitor is the most effective management strategy, with symptom resolution typically occurring within a few days. Physicians should be aware of this potential side effect and monitor patients accordingly to ensure timely intervention.
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