Tickly dry cough won't go away
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Persistent Tickly Dry Cough: Potential Link to ACE Inhibitors
ACE Inhibitors and Cough: An Overview
A persistent, tickly dry cough can be a common and bothersome side effect of angiotensin-converting enzyme (ACE) inhibitors, a class of medications widely used to treat conditions such as hypertension and heart failure. Studies indicate that approximately 10-15% of patients treated with ACE inhibitors may develop this type of cough . This adverse effect is consistent across various ACE inhibitors, including captopril, enalapril, lisinopril, ramipril, cilazipril, and quinapril, with no significant differences between these drugs .
Mechanisms Behind ACE Inhibitor-Induced Cough
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 increase the cough reflex . Additionally, stimulation of lung afferent C fibers by prostaglandin E2 and decreased breakdown of substance P, a neurochemical mediator of the cough reflex, are also implicated in this process.
Onset and Duration of Cough
The onset of the cough typically occurs within the first week of starting ACE inhibitor therapy but can also develop months or even a year later . The cough persists as long as the medication is taken and usually resolves within a few days after discontinuation of the ACE inhibitor .
Management and Recommendations
Given the high likelihood of recurrence, replacing one ACE inhibitor with another is generally not recommended, as the cough will almost always recur with rechallenge . The primary treatment for ACE inhibitor-induced cough is discontinuation of the medication, which typically leads to resolution of the cough within a few days . Physicians should be vigilant in recognizing this side effect and consider alternative treatments for patients experiencing a persistent dry cough while on ACE inhibitors.
Conclusion
A persistent tickly dry cough that won't go away may be a side effect of ACE inhibitors. Understanding the mechanisms, onset, and management of this adverse effect can help in making informed decisions about patient care. Discontinuation of the ACE inhibitor is the most effective way to resolve the cough, and alternative medications should be considered to avoid recurrence.
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