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.
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