Abstract:
Angiotensin Converting Enzyme Inhibitors (ACEI)
are widely used in clinical practice. Their use is often limited by cough. The
incidence of cough among patients taking ACEls varies widely. The reported
figures range from 2 - 33% (1). This wide variation depends partly on the method
adopted to detect cough. (2) it is believed that the incidence of cough is high
among Asians. This study was conducted to find the incidence of cough in the
current users of ACEI in Sri Lanka. Materials and methods: We studied two
groups of patients; one on regular ACEI treatment and the other age, sex and
disease pattern matched controls that were not on ACEI, for a period of 9 months
from January 1988. The ACEI group has 236 patients (27% females) with mean
age of 55 years and the control group had 228 patients (27% females) with a mean
age of 55 years. Both groups had similar disease patterns. These patients were
from cardiac, diabetic, renal and general medical clinics of the National Hospital
of Sri Lanka and 2 private sector hospitals in Colombo. The ACEI group patients
were on ACEI for at least 4 weeks and all patients with lung signs were excluded
from both groups. Patients were interviewed with the aid of a questionnaire and
examined by the investigators. Results: In the ACEI group 80 (34%) had cough
and 14 (6.1%) of the control group had cough. The difference between the
incidences of cough amongst the groups was highly significant (p<0.001). In the
ACEI group 59% of patients with cough had mild cough; the rest needed
treatment for their cough. However, all were able to tolerate the ACEI inspite of
cough. In the ACEI group 25 females (40% of females) and 55 males (32% of
males) had cough (p-NS). 37% (25 of 93) of patients above the age of 60 and 31%
patients (45 of 143) below the age of 60 had cough inthe ACEI group (p-NS).
Conclusion: The incidence of cough in patients on ACEI treatment for various
indications was found to be 36% in Sri Lankan patients. The incidence of cough
was not significantly different among the sexes and amongst patients above and
below the age of 60 years.
