BRONCHOSPASM AND COUGH AS ADVERSE REACTIONS TO THE ACE-INHIBITORS CAPTOPRIL, ENALAPRIL AND LISINOPRIL - A CONTROLLED RETROSPECTIVE COHORT STUDY

1 We report a controlled retrospective cohort study of respiratory adv erse reactions to ACE inhibitors. Bronchospasm and cough occurred at a higher rate in patients treated with ACE inhibitors, no links with se x, past history of bronchospasm, drug type or dose were found. 2 Cohor ts of 1013 patients on angiotensin converting enzyme (ACE) inhibitors and 1017 patients on lipid lowering drugs (LLDs) were compared for the occurrence of new bronchospasm, relapse of previous bronchospasm, inc rease of current bronchospasm and cough. 3 The prevalence of bronchosp asm was 5.5% for patients on ACE inhibitors and 2.3% for patients on L LDs, P < 0.001. The relative risk of a bronchospasm adverse reaction f or a patient on an ACE inhibitor compared with a patient on a LLD was 2.39, 95% confidence interval 1.47 to 3.90. 4 No ACE inhibitor specifi city, or significant sex differences were found in the prevalence of b ronchospasm or cough after correcting for bias implicit in the origina l cohorts. The bronchospastic reactions were not dose dependent. 5 The prevalence of a past history of bronchospasm in patients reporting AC E inhibitor-induced bronchospasm (16%) was not significantly different from the prevalence in patients on ACE inhibitors without an adverse reaction (13%), P = 0.447. 6 The prevalence of ACE inhibitor cohort co ugh was 12.3% and 2.7% in the patients on LLDs, P < 0.0001. Cough did not occur more commonly in patients on ACE inhibitors who had experien ced any bronchospasm (28%) than in patients on LLDs with bronchospasm (27%).