Misdiagnosis and mistreatment of a common side‐effect – angiotensin‐converting enzyme inhibitor‐induced cough

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Dry cough is a common and well-documented side-effect of angiotensin-converting enzyme inhibitor (ACEi) treatment.• The recommended course of action in case of ACE-induced cough is substitution of the ACEi with other antihypertensive agents.• Misdiagnosis and mistreatment of ACEi-induced cough has not been studied before. WHAT THIS STUDY ADDS• In the general population, a significant and clinically relevant proportion of patients with ACE-induced cough are treated with antitussive agents.• These results suggest misdiagnosis and mistreatment of a well-known side-effect.• The estimated frequency of antitussive treatment of ACEi-induced cough is 15%. AIMSAngiotensin-converting enzyme inhibitors (ACEi) are frequently prescribed for various cardiovascular and renal diseases. A common side-effect of these drugs is a persistent dry cough. Physicians who fail to recognize a dry cough to be ACEi-related may attempt to treat it with antitussive agents instead of recommended ACEi substitution. Prescription behaviour in the general population considering treatment of the side-effect with antitussive agents has not been studied before. METHODSDrug dispensing data between 2000 and 2007 were retrieved from the IADB.nl database. A prescription sequence symmetry analysis was used to determine whether antitussive agents were prescribed more often following ACEi initiation than the other way around. A logistic regression model was fitted to determine predictors. RESULTSWe identified 27 446 incident users of ACEi therapy. One thousand and fifty-four patients were incident users of both ACEi and antitussives within a half-year time span. There was an excess of patients being prescribed antitussive agents after ACEi initiation (703 vs. 351), adjusted sequence ratio 2.2 [confidence interval (CI) 1.9, 2.4]. Female patients were more likely to be prescribed antitussive agents following ACEi therapy initiation, odds ratio 1.4 (CI 1.1, 1.9), age and co-medications were not significant predictors. CONCLUSIONSThere was a significant and clinically relevant excess of patients receiving antitussives after ACEi initiation. The results suggest that cough as a side-effect of ACEi is not recognized as being ACEi-related or is symptomatically treated with antitussive agents instead of ACEi substitution. The estimated frequency of antitussive treatment of ACEi-induced dry cough is 15%.British Journal of Clinical Pharmacology DOI:10.1111DOI:10. /j.1365DOI:10. -2125DOI:10. .2009 200 / Br J Clin Pharmacol / 69:2 / 200-203

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