Attenuation of angiotensin converting enzyme inhibitor induced cough by iron supplementation: role of nitric oxide

Abstract

The present study examined whether (1) the cough associated with angiotensin converting enzyme inhibitor therapy is attenuated by oral intake of iron and anti-oxidants, and (2) nitric oxide (NO) has any role in this attenuation. Of the 100 patients under investigation, cough occurred in 28 of them with preponderance in females. All the 28 patients were followed up for six weeks: the first two weeks were the observation period and the remaining four weeks the experimentation period. After the observation period, 11 patients received a single oral dose of ferrous sulphate (200 mg), eight received vitamin E (200 mg, o.d.) and vitamin C (150 mg, o.d.) and nine were given placebo during the experimentation period. Cough scoring, serum NO and malondialdehyde (MDA) levels were determined during both the periods. While there were significant decreases in cough scores, NO and MDA levels between these two periods in the iron group, cough scores and MDA level decreased significantly in the anti-oxidant group. None of these parameters changed in the control group. NO level was found to be increased significantly in patients who developed cough (n = 28) compared with those who did not cough (n = 72). These results suggest that iron supplementation suppresses cough in patients on ACE-I therapy through its effect on NO generation.

Serum Iron Level as a Potential Predictor of Coronavirus Disease 2019 Severity and Mortality: A Retrospective Study

“…However, the percentage of patients with a cough was higher in our study (82% vs 67.8%) [12]. Serum iron was found to be closely correlated with chronic cough [9,13,14]. Previous research showed that nonsmoking women with chronic unexplained cough should be checked for iron deficiency and iron supplementation may resolve this symptom [9].…”

“…Previous research showed that nonsmoking women with chronic unexplained cough should be checked for iron deficiency and iron supplementation may resolve this symptom [9]. It was intriguing that oral intake of iron attenuated ACE inhibitor therapy related cough through its effect on nitric oxide generation [13]. These results suggest that iron deficiency might be one of reasons why cough symptoms accounted for a major percentage of the symptoms in COVID-19 patients.…”

The use of natural health products by paediatric patients in respite care

“…However, the integration of supplements into current pharmacotherapeutic approaches to patient care can be considered in selected cases. Some NHPs may decrease the risk of side effects from conventional drugs such as iron's reduction of dry cough due to angiotensin-conversing-enzyme inhibitor use (35,36). Other NHPs could reduce the need for nonsteroidal antinflammatory drugs and acetaminophen, and indirectly decrease their side effects.…”