Medication cause cough
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Some studies suggest that certain medications, such as ACE inhibitors, ARBs, and inhalation pharmaceuticals, can cause cough, while other studies highlight the effectiveness of specific drugs in reducing cough after anesthesia.
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Medication-Induced Cough: Causes and Mechanisms
Introduction to Medication-Induced Cough
Cough is a common reflex that serves as a defensive mechanism to clear the airways. However, it can also be a side effect of various medications, leading to chronic or acute cough that can significantly impact a patient's quality of life. Understanding the medications that cause cough and their mechanisms is crucial for effective diagnosis and management.
Common Medications That Cause Cough
Angiotensin-Converting Enzyme Inhibitors (ACEIs)
Angiotensin-converting enzyme inhibitors (ACEIs) are well-documented for causing a persistent, dry cough in a significant number of patients. The incidence of ACEI-induced cough ranges from 5% to 35% among users. The cough is believed to be caused by the accumulation of bradykinin and substance P, which are normally degraded by ACE. These substances can accumulate in the respiratory tract when ACE is inhibited, leading to cough. The only effective treatment for ACEI-induced cough is discontinuation of the medication.
Angiotensin Receptor Blockers (ARBs)
While ARBs are often considered as alternatives to ACEIs, they can also cause cough, although the incidence is generally lower compared to ACEIs. The exact mechanism is not as well understood, but it is thought to be related to similar pathways involving bradykinin and other mediators.
Other Medications
Other drugs that have been reported to cause cough include omeprazole and leflunomide. These cases are less common but should be considered, especially when common causes of chronic cough have been excluded.
Mechanisms of Drug-Induced Cough
Sensitization of Cough Reflexes
Medications can cause cough by sensitizing the cough reflex. This can occur through peripheral or central mechanisms. Peripheral sensitization involves the activation of cough receptors in the airways, while central sensitization involves changes in the neural pathways that process cough signals.
Inhalation Pharmaceuticals
Inhalation drugs, including those used for asthma and COPD, can also induce cough. This is often due to the activation of transient receptor potential (TRP) channels in airway nerves by chemical or mechanical stimuli. Factors such as the type of inhaler, drug formulation, and excipients can influence the likelihood of cough.
Management of Medication-Induced Cough
Discontinuation and Substitution
The primary approach to managing medication-induced cough is to discontinue the offending drug. For ACEI-induced cough, switching to an ARB may be effective, although monitoring for cough recurrence is necessary.
Use of Antitussives
In cases where discontinuation is not possible, antitussive medications may be used. Opioids like codeine and morphine are effective but come with significant side effects such as drowsiness and dependence. Non-opioid alternatives, including nociceptin and neurokinin receptor antagonists, are being explored as potential treatments.
Conclusion
Medication-induced cough is a significant clinical issue that requires careful consideration of the patient's medication history. ACEIs are the most common culprits, but other drugs can also cause cough through various mechanisms. Effective management involves discontinuation of the offending drug and, if necessary, the use of antitussive medications. Understanding these mechanisms and treatment options can help improve patient outcomes and quality of life.
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