Delay of diagnosis and empiric treatment of angiotensin-converting enzyme inhibitor-induced cough in office practice
C. G. Olsen
Department of Family Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
OBJECTIVE: To evaluate the length of time taken to diagnose cough due to
the use of an angiotensin-converting enzyme (ACE) inhibitor and the
frequency of interim diagnoses and treatments given in an office practice.
DESIGN: Retrospective case study. SETTING: Two academic group family
practice offices. PATIENTS: Seventeen solicited cases of patients with
suspected or known ACE inhibitor-induced cough over a 2-year period. MAIN
OUTCOME MEASURES: Documentation in the patient chart of the nature and
complaint of the cough; the time between initiation of therapy with the
drug and complaint of the cough; the time between initiation of therapy
with the drug and assessment of ACE inhibitor-induced cough or
discontinuation of drug treatment; other diagnoses given to explain the
cough; and other treatments given. RESULTS: There was an average of 14.5
weeks between the initiation of ACE inhibitor therapy and the first
documentation of the complaint of cough, and an average of 24.0 weeks
between the initiation of ACE inhibitor therapy and documentation of the
cough side effect. Physicians made several interim diagnoses prior to
recognizing cough as a side effect of ACE inhibitor therapy. Physicians
prescribed 30 medications and took two chest radiographs on seven patients
experiencing ACE inhibitor-induced cough prior to recognition of this side
effect. CONCLUSIONS: The investigation found a significant delay in making
the final diagnosis of ACE inhibitor-induced cough. Frequently, physicians
gave other diagnoses, ordered unnecessary diagnostic tests, and ordered
treatments other than the discontinuation of ACE inhibitor therapy. Earlier
identification would be more cost-effective.
