Statin-induced cough
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Statin-Induced Cough: Incidence and Case Reports
Statin-induced cough is a rare but documented side effect. Case reports have described patients developing a persistent dry cough after starting statin therapy, specifically with simvastatin and fluvastatin. In these cases, discontinuation of the statin led to resolution of the cough, suggesting a direct association between statin use and the onset of cough symptoms 12. These reports highlight that while cough is not a common adverse effect, it can occur and may necessitate stopping the medication.
Mechanisms of Statin-Induced Cough: Airway and Inflammatory Pathways
Experimental studies in animal models have provided insight into possible mechanisms behind statin-induced cough. Simvastatin has been shown to cause plasma extravasation in the airways and to exacerbate bronchoconstrictive responses to agents like bradykinin and capsaicin. This effect appears to involve the release of bradykinin, activation of bradykinin B2 receptors, nitric oxide (NO) production, and subsequent activation of TRPV1 receptors, all of which can contribute to cough and airway irritation . These findings suggest that statins may influence airway sensitivity and inflammation in susceptible individuals.
Statins and Cough in Chronic Respiratory Diseases
In contrast to the rare reports of statin-induced cough, several studies have investigated the use of statins as a treatment to reduce cough in patients with chronic respiratory diseases such as bronchiectasis. Randomized controlled trials have shown that high-dose atorvastatin can significantly improve cough-related quality of life scores in patients with bronchiectasis, as measured by the Leicester Cough Questionnaire (LCQ) 567. These improvements are thought to be related to the anti-inflammatory effects of statins, including enhanced apoptosis of airway neutrophils and reduced systemic inflammation 679. However, in patients with severe bronchiectasis and chronic Pseudomonas aeruginosa infection, atorvastatin did not significantly improve cough as the primary endpoint, though it did improve other quality of life measures and reduced inflammation .
Statins and Cough in Acute Respiratory Infections
The relationship between statin use and cough during acute respiratory infections is less clear. A prospective cohort study of pilgrims during the Hajj found that statin use did not significantly influence the occurrence of cough or fever during the pilgrimage, suggesting that statins do not affect the incidence of acute febrile cough episodes in this setting . However, in patients with diabetes and COVID-19, statin use was associated with a lower risk of developing chronic cough and dyspnea during follow-up, indicating a potential protective effect in certain populations .
Conclusion
Statin-induced cough is a rare but recognized adverse effect, with case reports confirming its occurrence and resolution upon discontinuation of the drug. Mechanistic studies suggest involvement of airway inflammatory pathways. Conversely, in chronic respiratory diseases, statins may actually help reduce cough and improve quality of life due to their anti-inflammatory properties. In acute respiratory infections, the evidence does not support a significant effect of statins on cough incidence, though some benefit has been observed in specific populations such as diabetic patients with COVID-19. Overall, while statin-induced cough is uncommon, clinicians should be aware of this potential side effect, especially when patients present with unexplained chronic cough.
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