ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR ASSOCIATED COUGH - A POPULATION-BASED CASE-CONTROL STUDY

The objectives of this study were to determine the risk for coughing a s an adverse reaction to angiotensin converting enzyme (ACE) inhibitor s under everyday circumstances in a large population and to study whet her this adverse effect is more common in women. A population-based ca se-control study was used. The study was set in the practices of 161 D utch general practitioners (GPs), in which all consultations, morbidit y, mortality, medical interventions and prescriptions were registered during 4 consecutive 3-month periods in 4 consecutive groups of 40-41 GPs. The subjects were 2436 patients with incident coughing and up to 3 controls per case were obtained (total group: 7348 controls), matche d for GP and a contemporary consultation in the same 3 months. All cas es and controls were 20 years or older and had no notification of resp iratory infections, influenza, tuberculosis, asthma, chronic bronchiti s, emphysema, congestive heart failure, sinusitis, laryngitis, haemopt ysis of respiratory neoplasms during the 3-month period. The results s howed that cases were 3.6 times as likely as controls to have been exp osed to ACE inhibitors (95% CI: 2.4-5.5) but after adjustment for pote ntial confounders the odds ratio was 2.5 (95% CI: 1.6-3.9). The crude odds ratio for males was 2.7 (95% CI: 1.4-5.1) and for females 4.2 (95 % CI: 2.4-7.5). The adjusted odds ratio for males was 1.8 (95% CI: 0.9 -3.5) and for females 2.7 (95% CI: 1.5-4.8). Cases were 2.7 (95% CI: 1 .3-5.9) and 3.9 (95% CI: 2.3-6.5) times as likely as controls to have been exposed to captopril and enalapril, respectively but the adjusted odds ratio for enalapril, 2.3 (95% CI: 1.4-3.9) was higher than for c aptopril, 1.8 (95% CI: 0.8-3.8). In conclusion we can say that the ris k for coughing is increased two- to threefold among ACE inhibitor user s. Although the odds ratio for females is higher than the odds ratio f or males, the difference is modest.