Firstly, they block the angiotensin-converting enzyme preventing blood vessels constricting. A larger diameter blood vessel means lower pressure. Secondly, they inhibit the release of the hormone aldosterone. This increases the excretion of water and sodium, reducing the volume of fluid in your body and thereby decreasing blood pressure. Well, the mechanism of ACE inhibitor cough is not completely understood but most researchers believe it involves excess inflammatory proteins bradykinins and tachykinins accumulating in the upper airways.
These kinins are normally degraded by angiotensin converting enzyme but when they accumulate they cause excess production of nitric oxide, a molecule that is inflammatory and irritating to the lining of the airways. A randomised, doubled blinded placebo controlled trial of 19 patients with ACE inhibitors cough showed that iron supplementation of mg ferrous sulphate over four weeks significantly reduced the cough scores.
Well, we need to go back to the role of excess nitric oxide in triggering ACE inhibitor cough. To generate nitric oxide you need another enzyme call nitric oxide synthase NOS. The benefits seen with the antioxidants are likely to relate to the reduction of inflammation. Iron supplementation is worth considering for relief of ACE inhibitor cough. The dose used in the studies equates to about 60mg of elemental iron per day.
This is on the higher end of the supplementation scale and before taking these doses you should consult with your healthcare practitioner so they can assess your current iron levels. Alternative forms such as amino acid chelates or bis-glycinates are better options. Antioxidants such as Vitamin E and Vitamin C are also going to be beneficial for the cough and healthy blood pressure as well as many other things.
The above diseases are more common in elderly patients, leading to a high incidence of ACEI-associated cough among the elderly population. Omboni et al. In addition, some patients experienced the relief of symptoms over time Cough as an adverse reaction occurred at a low frequency when the medication was taken at bedtime or combined with concomitant calcium antagonists or diuretics In 27, patients with cardiovascular disease, 1, patients discontinued the ACEI perindopril due to cough 3.
A study on the clinical prediction rule for ACEI-associated cough indicated that the independent multivariate predictors of cough were older age, female sex, non-African American race with East Asians having the highest risk , no history of previous ACEI use, and a history of cough due to another ACEI ARBs can be used as an alternative treatment for patients with ACEI drug intolerance because they cause a lower incidence of cough, are better tolerated and obtain similar or better antihypertensive effects 4.
ACEI-associated cough might be influenced by multiple factors. In addition to substance P, ACEIs might also affect ACE function in susceptible patients, and an increase in the level of kinin might be caused by a gene polymorphism of the bradykinin receptor 42 , Therefore, the incidence of ARB-associated cough is significantly lower than that of ACEI-associated cough in this specific population. Cough is one of the most common complications of opioids.
The following aspects may be involved in the mechanism underlying opioid-induced cough. First, opioids may inhibit central sympathetic outflow and, in turn, activate the vagus nerve. The enhancement of the parasympathetic nervous system is suggested to cause cough and bronchoconstriction 5 , Second, the pulmonary chemoreflex may be another likely mechanism.
Studies have shown that fentanyl and morphine may cause coughing by promoting the release of histamine, which could enhance the excitability of rapidly adapting receptors RARs 51 , Third, opioid receptors exist in the upper pulmonary mucosa and opioid-induced tracheal and bronchial smooth muscle constriction may trigger the cough reflex Moreover, opioid-induced muscle rigidity, which can cause sudden adduction of the vocal cords or supra-glottic obstruction by soft tissue, may be a possible mechanism 53 , Former smokers are more likely than current smokers to experience cough, according to a study about the association of fentanyl-induced cough and smoking Desensitization of the cough receptors within the airway epithelium and increased airway mucus secretion covering cough receptors after long-term tobacco smoking may be a possible mechanism for the suppression of cough sensitivity in smoking patients 56 , The statins 3-hydroxymethylglutaryl coenzyme A HMG-CoA reductase inhibitors can effectively reduce plasma low-density lipoprotein LDL levels and cholesterol levels, improving the incidence of cardiovascular events and mortality 58 , Patients diagnosed with hypercholesterolemia and undergoing treatment with statins can experience a series of side effects including coughing, and all the symptoms achieve remission after discontinuation of the treatment for 7—15 days, although the improvement rate of cough only reaches There might be two possible explanations for statin-induced cough.
First, the administration of statins could induce PG synthase and increase prostacyclin production, which might cause coughing. Second, statins could stabilize the mRNA of endothelial nitric oxide NO synthase, leading to enhanced enzyme expression and NO generation that could increase cough reflex sensitivity According to the case report, statins have interstitial lung disease as a side effect, which could manifest as coughing, but the specific mechanism leading to lung injury is unknown Our nutrition guide can help.
ACE inhibitors. In: StatPearls [Internet]. Updated July 8, Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore. Singapore Med J. Angiotensin-converting enzyme inhibitors induce cough. Turk Thorac J. Angiotensin-converting enzyme inhibitors vs. Am Fam Physician. The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis.
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Risk Factors. Should You Switch Medications? Recap All ACE inhibitors have the potential to cause coughing. Recap Taking ACE inhibitors can lead to an increase in a substance called bradykinin.
Side Effects of Blood Pressure Medications. Recap The only way to treat ACE inhibitor-related cough is to stop treatment and switch to another type of drug. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.
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