[Dysphagia] ACE inhibitors, cough and angioedema

[eripley at yahoo.com (Irene Campbell-Taylor)]

Over the years on this list there has been discussion about the side effect of cough with ACE inhibitors and not confusing it with misdirected swallow cough. Thegenerally expressed view has been that chronic cough is rare, despite clinical evidence to the contrary. It now appears that physicians, especially cardiologists are not very aware of jsut how common these problems are with ACE inhibitors:

 Are Physicians Aware of the Side Effects of Angiotensin-Converting Enzyme Inhibitors? A Questionnaire Survey in Different Medical Categories Chest. 2005;128:976-979

Carlo Lombardi, MD; Mariangiola Crivellaro, MD; Annarita Dama, MD; Gianenrico Senna, MD; Sabrina Gargioni, MD and Giovanni Passalacqua, MD 

 

Study objective: Angiotensin-converting enzyme inhibitors (ACE-I) are considered safe, but they are associated with characteristic side effects, namely cough and angioedema, usually requiring discontinuation. We perceived that referrals for these side effects have become more and more frequent; therefore, we evaluated the degree of knowledge on the safety of ACE-I in different medical categories. 

Design: A questionnaire (13 questions) on side effects of ACE-I was posted to physicians. 

Setting: Everyday clinical practice. 

Participants: Cardiologists, allergists, and general practitioners (GPs). 

Measurement and results: Three hundred twelve physicians were contacted, and 154 returned questionnaires that could be analyzed. Of the 154 physicians (mean age, 45 years) 48 were cardiologists, 52 were GPs, and 54 were allergists. The percentage of correct answers was low: 31.9% for cardiologists, 40% for GPs, and 33% for allergists. Thus, GPs provided a significantly higher percentage of correct answers with respect to the remaining categories (p = 0.05). The lower rate of correct answers (0 to 15.9%) concerned the time of onset of cough and the action to take. Cardiologists seemed to be less aware of the fact that angiotensin receptor blockers (sartans) can cross-react with ACE-I. 

Conclusion: Overall, there was a poor knowledge of the side effects of ACE-I. This may account for the increased referrals for chronic cough and angioedema. 

 



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com