ACEI treatment and chronic cough

Imran Satia, MD, PhD, is an assistant professor in the Division of Respirology at McMaster University.

Angiotensin-converting enzyme inhibitors (ACEIs) are a common cause of chronic cough. What is the typical time between starting the ACEI treatment and the occurrence of cough? How long should we wait for suspected ACEI-induced cough to resolve?

You’re absolutely right that an ACEI is the commonest drug to cause chronic cough. There’s actually not much data available about how long after starting an ACEI the cough starts. In my experience, I’ve noticed that people who do have ACEIs, they often have been taking it for ≥5 years. Often they find it confusing when we suggest to them that we should change the ACEI or switch to a completely different class like angiotensin receptor blockers (ARBs) or even a calcium channel blocker. There often can be a very delayed onset.

The second point is that once we identify that the patient is on an ACEI, then we often stop them. I advise patients that it might take ≥3 months and in 30% to 40%, maybe a half [of them] the cough does reduce in intensity and frequency.

Unfortunately in some patients, even after changing the ACEI, the cough doesn’t go away. The patients are still left with the problem of chronic cough.