In addition to cough some patients taking an angiotensin converting enzyme (ACE) inhibitor may develop bronchial constriction and/or spasm.


Mechanism: Bradykinin has been implicated in the cough associated with ACE inhibitors. Substance P may cause bronchoconstriction.


An ACE inhibitor may worsen symptoms in a patient with asthma.


A person taking an ACE inhibitor may have worsening of symptoms following exposure to factors causing bronchospasm (inhaled allergens, viral infections, etc.)


Patient at risk for symptoms:

(1) family history (associated with bradykinin or substance P receptors)

(2) female gender

(3) Asian or Afro-American race


Ways to reduce the cough and/or bronchoconstriction:

(1) Reduce the dose of the ACE inhibitor.

(2) Change to another antihypertensive medication.

(3) Give cromolyn.


To read more or access our algorithms and calculators, please log in or register.