Differences of Cough in Drugs that Inhibit ACE and in Bronchitis

Posted: December 07, 2018

Differences of Cough in Drugs that Inhibit ACE and in Bronchitis




Differences of Cough in Drugs Inhibiting ACE and in Bronchitis

The treatment of hypertension utilizes, among many other drug classes, angiotensin-converting enzyme (ACE) inhibitors. These agents halt the production of angiotensin II from angiotensin I. The enzyme is also involved in inhibition of the breakdown of mediators of inflammation which includes tachykinins such as substance P and bradykinins (Poole & Postma, 1991). The accumulation of these substances leads to the development of a cough as the adverse effects. Some of the common ACE inhibitors used are lisinopril, enalapril, and captopril. On the other hand, bronchitis which may either present as acute or chronic occurs due to cigarette smoking, environmental irritants such as nitrogen dioxide, and due to microbial infection (Kumar, Abbas, & Aster, 2013).

A cough caused by these two etiologies can be differentiated further by considering the presenting symptoms. In the case of ACE inhibitors, characteristic dry cough occurs with the onset of medication. It is dry and nonproductive with a tickling effect in the airway that has been approximated to occur at the sternal notch (Poole & Postma, 1991). At night, its severity increases leading to sleep disturbances and may be accompanied by wheezing (Katzung, Masters, & Trevor, 2012). Touching of the anterior and lower neck can also provoke the symptoms. Thus, the cough occurs as an adverse drug reaction to the ACE inhibitors antihypertensive drugs and can resolve 2-7 days following the discontinuation of medication (Poole & Postma, 1991). On the contrary, bronchitis is characterized by a persistent productive cough. Sputum produced may either be clear, blood-tinged, and yellow or even green (Fayyaz, 2017). Patients may have stuffy or runny noses with and headache, muscle aches and fatigue (Fayyaz, 2017). In severe cases, chest pain and general malaise may ensure. On physical examination, a diffuse wheeze, inspiratory stridor, and heaves may be noted. Bronchitis can persist for as short as two weeks in acute cases or for more than three months in severe chronic cases.




Fayyaz, J. Bronchitis. Retrieved on May 2, 2017 from http://emedicine.medscape.com/article/297108-overview

Katzung, B.G., Masters, S.B., & Trevor, A.J. (2012). Basic & clinical pharmacology. New York: McGray-Hill Medical.

Kumar, V., Abbas, A.K., & Aster, J.C. (2013). Robbins Basic Pathology. Philadelphia: Elsevier/Saunders.

Poole, M. D., & Postma, D. S. (1991). Characterization of cough associated with angiotensin-converting enzyme inhibitors. Otolaryngology – Head and Neck Surgery, 105(5), 714-716.