Tag Archive for: chronic cough

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Your Medicine May Be Making You Cough

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Angiotensin-Converting Enzyme (ACE) Inhibitors found in some prescription medications can be associated with Chronic Cough.  It is important to never stop a medication without first discussing the consequences with the ordering physician.  But a Cough Doctor can precisely diagnose the cause(s) of your Chronic Cough and the role of ACE Inhibitor medication in your situation.

A persistent, dry, tickling cough is a relatively common result of ACE inhibitors, such as lisinopril, which are used to treat hypertension, heart and kidney diseases. Cough may occur within hours of the first dose of medication, or its onset can be delayed for weeks to months after the initiation of therapy. Treatment with ACE inhibitors may sensitize the cough reflex, thereby potentiating other causes of chronic cough.

The mechanism of ACE inhibitor induced cough is not fully understood but probably is associated with increases in bradykinins that activate the cough reflex. Although cough usually resolves within 1 to 4 weeks of the cessation of therapy with the offending drug, in a subgroup of individuals cough may linger for up to three months. A different drug class, angiotensin receptor blockers (ARBs), do not cause cough, even in those patients with a history of ACE inhibitor-induced cough.

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What’s Making Me Cough?

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Sequence of Actions in the Cough Reflex Pathway Resulting in Cough

The chronic cougher tends to have an increased urge to cough. It can be described as a tickle in the back of the throat. Sometimes it can be a feeling that something is stuck there. Often, there is a feeling of post nasal drip, but rarely any is produced. A hypersensitive or heightened cough reflex requires less stimuli, such as nasal secretions, airborne irritants, acid or gastroesophageal reflux, to trigger a chronic cough. What creates these feelings?

  • Cough receptors in the upper airway (nose), larynx (voice box), lung, and esophagus are activated by direct irritation such as throat infection, post nasal drip or gastric acid (which has contact with the receptors in the larynx/voice box)
  • The receptors send a signal to the cough center in the lower brain area
  • The cough center then decides if there is enough stimulus to set off a cough
  • The cough center becomes hyperactive by repeated stimulation from the peripheral cough receptors
  • The cough center is also influenced by higher brain function which can result in a voluntary and habit cough
  • Stimulation of the upper airway, esophagus, and lung can heighten or sensitize the cough reflex without actually triggering off a cough. For example, acid or even food entering the esophagus from the stomach can send signals to the cough center to become more sensitive or irritable. Allergic nasal symptoms also send signals to the cough center and increase sensitivity.