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慢性咳嗽

著者: 鎌田一宏 福島県立医科大学 会津医療センター 総合内科

監修: 山中克郎 福島県立医科大学会津医療センター総合内科

著者校正/監修レビュー済:2021/11/02
参考ガイドライン:
日本呼吸器学会:咳嗽・喀痰の診療ガイドライン2019. 2019
患者向け説明資料

概要・推奨   

  1. 鎮咳作用においてメジコンはリン酸コデインと同等の効果が期待できる。そのためメジコンの使用が鎮咳の第1選択として推奨される(推奨度2)。
  1. 咳喘息の診断と治療に吸入気管支拡張薬が有用である(推奨度2)。
  1. 咳喘息の治療には吸入ステロイドが推奨される(推奨度2)。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
鎌田一宏 : 未申告[2021年]
監修:山中克郎 : 未申告[2021年]

改訂のポイント:
  1. 定期レビューを行い、疫学・病態・注意事項、および問診・診察のポイントについて要点の修正を行った。

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 3週間以上8週間未満の咳嗽持続を遷延性咳嗽、8週間以上を慢性咳嗽と定義する。
  1. 遷延性咳嗽は感染後咳嗽が原因として多いが[1]、慢性咳嗽は非感染性が主体となる[2][3]
  1. 以下の疾患は頻度が高いとされるが、原因は複数にわたることもある(例:咳喘息と逆流性食道炎)。
  1. 咳喘息/喘息
  1. 副鼻腔気管支症候群
  1. 胃食道逆流症
  1. 喉頭アレルギー
  1. アトピー咳嗽
  1. 感染後咳嗽
  1. アンジオテンシン変換酵素(ACE)阻害薬
  1. 慢性閉塞性肺疾患(COPD)
  1. 喫煙
  1. 慢性咳嗽の原因疾患は欧米と相違がある。欧米では咳喘息、後鼻漏、胃食道逆流症の頻度が高いとされているが、日本では咳喘息は高頻度にみられるが、後鼻漏、胃食道逆流症の頻度は必ずしも高くない[4]
 
問診・診察のポイント  
  1. 病歴聴取、身体所見、胸部X線写真は慢性咳嗽診断の基本ワークアップである。

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11月30日(火)までにお申込みいただくと、
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文献 

著者: Nam-Hee Kwon, Mi-Jung Oh, Tae-Hoon Min, Byung-Jae Lee, Dong-Chull Choi
雑誌名: Chest. 2006 May;129(5):1142-7. doi: 10.1378/chest.129.5.1142.
Abstract/Text STUDY OBJECTIVES: Cough lasting > 3 weeks has been defined as chronic cough. However, it might be more persuasive to divide cough into subacute, lasting 3 to 8 weeks, and chronic, lasting > 8 weeks. We evaluated the causes and clinical courses of subacute cough, and the value of the bronchoprovocation test and induced sputum examination (IS).
METHODS: Nonsmoking patients with cough of 3 to 8 weeks duration were enrolled into the study. Patients with dyspnea, basal FEV1 of < 70% predicted, abnormal findings on a plain chest radiograph or physical examination were excluded. We prescribed an antihistamine-decongestant for patients who were suspected to have postinfectious cough or postnasal drip. If patients had positive results on a bronchoprovocation test or IS, therapy with inhaled corticosteroids was substituted according to an algorithmic approach.
RESULTS: One hundred eighty-four patients (77 men and 107 women) were evaluated; the mean age of the study group was 47.5 years. Eighty-nine of 184 patients had postinfectious cough. Cough resolved without treatment in 62 patients. Twenty-nine of 43 patients with positive bronchoprovocation test results had cough-variant asthma.
CONCLUSIONS: Postinfectious cough was the most common cause of subacute cough. The spontaneous resolution of cough was frequent in patients with subacute cough. Unless asthma was strongly suspected, the performance of the bronchoprovocation test could be delayed until after empirical treatment had been administered.

PMID 16685003  Chest. 2006 May;129(5):1142-7. doi: 10.1378/chest.129.5・・・
著者: Kian Fan Chung, Ian D Pavord
雑誌名: Lancet. 2008 Apr 19;371(9621):1364-74. doi: 10.1016/S0140-6736(08)60595-4.
Abstract/Text Cough is a reflex action of the respiratory tract that is used to clear the upper airways. Chronic cough lasting for more than 8 weeks is common in the community. The causes include cigarette smoking, exposure to cigarette smoke, and exposure to environmental pollution, especially particulates. Diseases causing chronic cough include asthma, eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip syndrome or rhinosinusitis, chronic obstructive pulmonary disease, pulmonary fibrosis, and bronchiectasis. Doctors should always work towards a clear diagnosis, considering common and rare illnesses. In some patients, no cause is identified, leading to the diagnosis of idiopathic cough. Chronic cough is often associated with an increased response to tussive agents such as capsaicin. Plastic changes in intrinsic and synaptic excitability in the brainstem, spine, or airway nerves can enhance the cough reflex, and can persist in the absence of the initiating cough event. Structural and inflammatory airway mucosal changes in non-asthmatic chronic cough could represent the cause or the traumatic response to repetitive coughing. Effective control of cough requires not only controlling the disease causing the cough but also desensitisation of cough pathways.

PMID 18424325  Lancet. 2008 Apr 19;371(9621):1364-74. doi: 10.1016/S01・・・
著者: Akio Niimi
雑誌名: Pulm Pharmacol Ther. 2007;20(4):383-7. doi: 10.1016/j.pupt.2006.10.014. Epub 2006 Nov 1.
Abstract/Text Cough is the most common complaint that leads patients to seek medical attention. Especially chronic persistent cough is annoying, and requires appropriate diagnosis and treatment. Recent cough guidelines and original papers on cough epidemiology from various countries show remarkable differences in the aetiology of chronic cough among countries, especially between US, UK and Japan. Entities associated with rhinosinus disease (post-nasal drip/upper airway cough syndrome reported from the US, rhinitis or rhinosinusitis from the UK, and sinobronchial syndrome from Japan), and eosinophilic lower airway disorders (cough variant asthma, non-asthmatic eosinophilic bronchitis and atopic cough) are most confusing and might involve significant overlap. In this article, issues related to chronic cough aetiology are discussed, including geographic issues, e.g. 'simple' geography or difference in race, and difference in patient characteristics possibly arising from difference in the medical system.

PMID 17169594  Pulm Pharmacol Ther. 2007;20(4):383-7. doi: 10.1016/j.p・・・
著者: Makiko Jinnai, Akio Niimi, Tetsuya Ueda, Hirofumi Matsuoka, Masaya Takemura, Masafumi Yamaguchi, Kojiro Otsuka, Tsuyoshi Oguma, Tomoshi Takeda, Isao Ito, Hisako Matsumoto, Michiaki Mishima
雑誌名: Chest. 2010 May;137(5):1122-9. doi: 10.1378/chest.09-0081. Epub 2010 Jan 15.
Abstract/Text BACKGROUND: Mucus hypersecretion is an important pathophysiologic index of airway disease. Measurement of secreted mucin in sputum has been reported in asthma, but not in chronic cough with or without increased sputum production.
METHODS: We studied 49 patients with classic asthma (CA), 39 with cough-variant asthma (CVA), nine and five with chronic cough associated with sinobronchial syndrome (SBS) and gastroesophageal reflux disease (GERD), respectively, and 11 healthy controls. Seventeen patients with CA, but none from the other groups, were taking antiinflammatory medications. Mucin levels in induced sputum supernatants were measured by enzyme-linked immunosorbent assay, which detects airway mucin, probably including MUC5AC and MUC5B.
RESULTS: Mucin levels were higher in patients with CA (674.2 +/- 548.8 microg/mL) and SBS (638.4 +/- 650.7 microg/mL) than in controls (212.0 +/- 167.1 microg/mL) (P = .0037 and .044). They were also higher in patients with CA than in those with CVA (350.4 +/- 374.0 microg/mL) and GERD (134.3 +/- 93.1 microg/mL) (P = .0016 and 0.015), but results did not differ between the latter groups and controls. When the four disease groups were combined, patients with frequent sputum production had greater mucin levels than those with occasional (P = .0023) or no sputum production (P < .0001). Patients with CA showed negative correlations of mucin levels with respiratory resistance indices on impulse oscillation and with airway sensitivity to methacholine.
CONCLUSIONS: Sputum mucin levels differ in various respiratory conditions when compared with controls, primarily reflecting the degree of sputum production. Airway mucin might possibly exert protective effects in asthma, at least between exacerbations, but this issue needs to be further clarified by future studies.

PMID 20081098  Chest. 2010 May;137(5):1122-9. doi: 10.1378/chest.09-00・・・
著者: A Niimi, R Amitani, K Suzuki, E Tanaka, T Murayama, F Kuze
雑誌名: Clin Exp Allergy. 1998 Feb;28(2):233-40. doi: 10.1046/j.1365-2222.1998.00217.x.
Abstract/Text BACKGROUND: The serum level of eosinophil cationic protein (ECP) has been used as a clinical marker in asthma, on the assumption that it reflects ongoing eosinophilic inflammation of the airways. However, only a few studies have investigated this issue, using bronchial secretions but not tissue specimens.
OBJECTIVE: To evaluate cross-sectionally the correlation between serum ECP level or blood eosinophil count, and the degree of eosinophilia in bronchoalveolar lavage fluid (BALF) and bronchial biopsy tissue, and disease activity, in asthmatic patients.
METHODS: Thirty-three adults with symptomatic asthma and six healthy controls were studied. The blood eosinophil count, ECP levels in serum and BALF, percentage of eosinophils in BALF, number of eosinophils in bronchial tissue, pulmonary function, and methacholine bronchial responsiveness of these subjects were clarified. An asthma severity score and inhaled beta2-agonist requirement (puffs/day) were also assessed for the asthmatic patients.
RESULTS: The asthmatic patients, compared with the controls, had more obstructive (as tested by %FEV1, FEV1/FVC, and FEF25-75%) and more responsive airways, and showed a significant increase in the number of eosinophils in the blood, BALF, and tissue, and in the serum ECP levels. The ECP levels in BALF were below the detection limit for most of the subjects in both groups examined. In the asthmatic patients, serum ECP level demonstrated correlations with the number or percentage of eosinophils in BALF and tissue, whereas the blood eosinophil count correlated only with the percentage of eosinophils in BALF. Serum ECP level correlated with all indices of disease activity examined; %FEV1, FEV1/FVC, FEF25-75% bronchial responsiveness, severity score and beta2-agonist usage, whereas the blood eosinophil count correlated only with %FEV1 and bronchial responsiveness.
CONCLUSION: The data suggest that serum ECP level reflects the intensity of eosinophilic airway inflammation, as well as the disease activity, and may be useful as an inflammatory marker in asthma.

PMID 9515598  Clin Exp Allergy. 1998 Feb;28(2):233-40. doi: 10.1046/j・・・
著者: H Matthys, B Bleicher, U Bleicher
雑誌名: J Int Med Res. 1983;11(2):92-100.
Abstract/Text Dextromethorphan, the most widely used cough suppressant in the U.S.A., was compared with codeine, the traditional European antitussive, in a double-blind, crossover trial using both an objective and subjective assessment of efficacy in sixteen patients with chronic, stable cough. Both preparations, at a dose of 20 mg, were similarly effective in reducing cough frequency. Dextromethorphan lowered cough intensity to a greater degree than codeine (p less than 0.0008) and was considered the better antitussive by the majority of patients (p less than 0.001). In view of its lack of side-effects, its safety even in overdose and its non-narcotic status, the increasing trend in Europe to use dextromethorphan as a substitute for codeine in the treatment of cough is to be welcomed.

PMID 6852361  J Int Med Res. 1983;11(2):92-100.
著者: M Aylward, J Maddock, D E Davies, D A Protheroe, T Leideman
雑誌名: Eur J Respir Dis. 1984 May;65(4):283-91.
Abstract/Text Plasma kinetics of dextromethorphan (as dextrorphan ) and codeine were investigated after acute oral doses in 8 patients with pathological cough; after which the patients participated in an acute dose-response study of the antitussive effects of each drug administered as syrups. Maximum plasma codeine concentrations averaged 384 ng.ml-1 (s.d. +/- 78.3) occurring between 0.75 and 2h after ingestion of 60 mg codeine phosphate; in comparison mean peak plasma dextrorphan levels were 386 ng.ml-1 (s.d. +/- 107.2) and 388 ng.ml-1 (s.d. +/- 101.3) respectively, after administration of 60 mg dextromethorphan syrup and tablet formulations. Bioavailability of dextromethorphan tablets was comparable to syrup. No correlation emerged between instantaneous plasma concentrations of either dextrorphan or codeine and antitussive responses; however, peak antitussive effect was significantly related to log dose with both drugs. Antitussive effects of 30 mg codeine phosphate and 60 mg dextromethorphan hydrobromide did not differ significantly; both were superior to 30 mg dextromethorphan hydrobromide and placebo.

PMID 6539224  Eur J Respir Dis. 1984 May;65(4):283-91.
著者: S Cheriyan, P A Greenberger, R Patterson
雑誌名: Ann Allergy. 1994 Dec;73(6):478-80.
Abstract/Text BACKGROUND: Cough variant asthma is defined as a persistent nonproductive cough with minimal wheezing or dyspnea. The uncontrolled coughing may interfere with sleep, work, and social activities. Cough precipitating fecal or urinary incontinence can be extremely distressing. The diagnosis is established within 1 to 2 weeks by a trial of prednisone, 30 mg a day. The cough will be controlled within that time and subsequent management can consist of inhaled corticosteroids.
OBJECTIVE: To evaluate the course of ten patients with cough variant asthma and their response to inhaled corticosteroids.
METHODS: Retrospective analysis of the presentation, diagnosis, course, and response to oral and inhaled steroids in ten patients with cough variant asthma.
RESULTS: Ten patients whose chief complaint was persistent debilitating cough for periods of 2 months to 20 years underwent a diagnostic and therapeutic trial of prednisone as previously described. At a mean follow-up period of 28 months all were free of debilitating cough. Eight of ten patients were still receiving inhaled steroids and two needed low dose alternate day oral steroid therapy. Two patients had complete remission of symptoms. None required daily inhaled or oral bronchodilators and there were no hospital admissions for respiratory symptoms.
CONCLUSIONS: Inhaled corticosteroid therapy after a diagnostic trial of oral steroids is effective for long-term control of cough variant asthma.

PMID 7998659  Ann Allergy. 1994 Dec;73(6):478-80.
著者: Toshiyuki Kita, Masaki Fujimura, Haruhiko Ogawa, Yasuto Nakatsumi, Satoshi Nomura, Yoshihisa Ishiura, Shigeharu Myou, Shinji Nakao
雑誌名: Allergol Int. 2010 Jun;59(2):185-92. doi: 10.2332/allergolint.09-OA-0112. Epub 2010 Mar 25.
Abstract/Text BACKGROUND: Chronic cough is the only symptom of cough variant asthma (CVA) and atopic cough (AC). Cysteinyl leukotriene receptor antagonists have been shown to be effective in CVA, but there are no reports on their effectiveness in AC. To evaluate the antitussive effect of montelukast, a leukotriene receptor antagonist, in CVA and AC.
METHODS: Seventy-five patients with chronic cough received diagnostic bronchodilator therapy with oral clenbuterol hydrochloride for 6 days. Of the 75 patients, 48 and 27 met the simplified diagnostic criteria for CVA and AC, respectively. Patients with CVA were randomly divided into 3 groups: montelukast, clenbuterol, and montelukast plus clenbuterol. Patients with AC were randomly divided into 2 groups: montelukast and placebo. The efficacy of cough treatment was assessed with a subjective cough symptom scale (0 meant "no cough" and 10 denoted "cough as bad as at first visit"). The cough scale, pulmonary function test, and peak expiratory flow rate (PEF) were evaluated before and after 2 weeks of treatment.
RESULTS: In patients with CVA, 2-week treatment with montelukast, clenbuterol, and montelukast plus clenbuterol all significantly decreased cough scores and treatment with montelukast plus clenbuterol was superior to treatment with montelukast alone. In the montelukast plus clenbuterol group, PEF values in the morning and evening significantly increased after 2 weeks compared with values before treatment. In patients with AC, scores on the cough scale did not differ significantly between the montelukast group and the placebo group.
CONCLUSIONS: Montelukast was confirmed to suppress chronic non-productive cough in CVA, whereas it was not effective in non-productive cough in AC.

PMID 20299826  Allergol Int. 2010 Jun;59(2):185-92. doi: 10.2332/aller・・・
著者: Jun Tamaoki, Naoko Yokohori, Etsuko Tagaya, Saori Kirishi, Yukari Miyamoto, Katsunori Ochiai, Mitsuko Kondo, Atsushi Nagai
雑誌名: Allergy Asthma Proc. 2010 Sep-Oct;31(5):78-84. doi: 10.2500/aap.2010.31.3366.
Abstract/Text Cough variant asthma (CVA) is a common cause of chronic persistent cough, in which allergic airway inflammation may play a role. Although current guidelines recommend bronchodilators and anti-inflammatory drugs for the treatment, comparison of the efficacy of these medications has not been investigated. This study was designed to evaluate the effectiveness of pranlukast, a leukotriene receptor antagonist, and salmeterol, a long-acting beta₂-adrenergic agonist, in the treatment of CVA. The study was a randomized, controlled, parallel-group, multicenter trial. After a 4-week run-in period, 49 patients with newly diagnosed CVA were assigned to receive oral pranlukast (225 mg, b.i.d.) or inhaled salmeterol (100 μg, b.i.d.) for 4 weeks. Primary outcome measure was cough symptom and secondary outcome measures were pulmonary function and eosinophilic airway inflammation. Treatment with pranlukast and salmeterol each decreased cough symptom scores, where the changes from baseline values were significantly greater in the pranlukast group than in the salmeterol group. Forced expiratory volume in 1 second and peak expiratory flow (PEF) increased in the two treatment groups with the same magnitudes, but significant decreases in diurnal variation of PEF and eosinophil counts and eosinophil cationic protein contents in the peripheral blood and induced sputum were observed only in the pranlukast group. In view of antitussive and anti-inflammatory actions, the leukotriene receptor antagonist pranlukast seems to be more effective than the long-acting beta₂-adrenergic agonist salmeterol in the treatment of CVA.

PMID 20929598  Allergy Asthma Proc. 2010 Sep-Oct;31(5):78-84. doi: 10.・・・
著者: Robert H Poe, Michael C Kallay
雑誌名: Chest. 2003 Mar;123(3):679-84.
Abstract/Text STUDY OBJECTIVE: To evaluate experience using a therapeutic trial of proton-pump inhibitor therapy with or without a prokinetic agent in diagnosis and treatment of gastroesophageal reflux disease (GERD)-related cough.
DESIGN: A review of experience with 214 patients with cough of > or = 3 weeks referred over 3.5 years. An anatomic diagnostic protocol was used to identify and treat those with GERD-related cough.
SETTING: A pulmonary specialty practice affiliated with the University of Rochester School of Medicine and Dentistry.
PATIENTS: One hundred eighty-three patients were identified with chronic cough and were included in the study. Thirty-one patients were disqualified because of abnormal chest radiographic findings, inadequate follow-up, or cough being not the primary complaint. Fifty-six patients were identified as having GERD-related cough.
INTERVENTIONS: A once-daily dose of a proton-pump inhibitor was prescribed. A prokinetic agent was added if esophageal dysfunction was suspected or response was inadequate. Those who did not respond underwent 24-h esophageal pH monitoring.
RESULTS: GERD was the single cause of cough in 24 patients (43%). Twenty-nine patients (52%) had GERD plus another cause, and 3 patients (5%) had GERD with more than two causes. Twenty-four patients (43%) had cough only, while 32 patients (57%) had other symptoms of GERD. Proton-pump therapy was successful in 42 patients (79%). Twenty-four patients responded to proton-pump inhibitor therapy, and 18 patients responded when metoclopramide or cisapride was added. The remaining two patients responded to a histamine type-2 blocker or cisapride alone. The cough was eliminated or markedly improved in 38 patients (86%) after 4 weeks and by 8 weeks in the remaining 6 patients. Six of the nonresponders had aspiration diagnosed by bronchoscopy. Four patients had fundoplication recommended, and two patients responded to alternative interventions.
CONCLUSIONS: Four to 6 weeks of a proton-pump inhibitor alone or in combination with a prokinetic agent successfully diagnoses and treats four of five patients with GERD-related cough. Twenty-four-hour esophageal pH monitoring will confirm the diagnosis in the others. These patients may be candidates for fundoplication. Nonresponders often aspirate as an additional aggravating factor.

PMID 12628862  Chest. 2003 Mar;123(3):679-84.
著者: T O Kiljander, E R Salomaa, E K Hietanen, E O Terho
雑誌名: Eur Respir J. 2000 Oct;16(4):633-8.
Abstract/Text Gastro-oesophageal reflux (GOR) is an important cause of chronic cough. There has been a lack of placebo-controlled trials treating GOR related chronic cough with antireflux therapy. The aim of this study was to determine the efficacy of omeprazole on GOR related chronic cough. After excluding other common causes of cough, oesophageal pH monitoring was performed on 48 patients with chronic cough. Twenty-nine patients found to have GOR were randomized in a double-blind fashion to receive omeprazole 40 mg o.d. or placebo for 8 weeks. After a 2-week washout period, patients were crossed over to the other treatment. Symptoms were recorded daily in a diary. Twenty-one patients completed both treatment periods. Cough (p=0.02) and gastric symptoms (p=0.003) improved significantly during the omeprazole treatment in twelve patients who received placebo during the first and omeprazole during the second 8-week period. In nine patients who received omeprazole during the first 8-week period, amelioration in cough reached statistical significance only after cessation of omeprazole. Gastric symptoms also remained minor during placebo in these nine patients. Omeprazole 40 mg o.d. seems to improve chronic cough in patients with gastrooesophageal reflux and the effect of omeprazole in ameliorating both cough and reflux symptoms continues after treatment ceases.

PMID 11106204  Eur Respir J. 2000 Oct;16(4):633-8.
著者: P W Holmes, C E Barter, R J Pierce
雑誌名: Respir Med. 1992 Sep;86(5):425-9.
Abstract/Text The clinical effects of inhaled ipratropium bromide were studied in 14 non-smoking patients with persistent post-viral infective cough employing a controlled double-blind, cross-over trial. Patients were selected if they demonstrated no apparent underlying cause for their persistent cough after appropriate radiological and respiratory function tests including methacholine reactivity and bronchoscopic examination. Inhaled ipratropium bromide (320 micrograms day-1) produced significantly less day and night time cough (P < 0.05) with overall clinical improvement in 12 cases, five of whom had total resolution of their cough. We conclude that ipratropium bromide is an effective treatment in non-smoking adults with protracted cough following clinical upper respiratory tract infection.

PMID 1462022  Respir Med. 1992 Sep;86(5):425-9.
著者: D Ravid, M Lishner, R Lang, M Ravid
雑誌名: J Clin Pharmacol. 1994 Nov;34(11):1116-20.
Abstract/Text Angiotensin-converting enzyme inhibitors (ACE-I) have become the mainstem of antihypertensive therapy and first-choice agents for vasodilatation in congestive heart failure (CHF). A typical dry cough is the main cause for discontinuation of ACE-I therapy. Data about the incidence, course, and clinical significance of this side effect are conflicting. This study determined the incidence of cough in ACE-I treated patients with hypertension and with CHF and to appreciate its clinical significance; 268 ACE-I treated patients, 164 with hypertension and 104 with CHF were prospectively followed for at least 1 year and specifically questioned about cough and other side effects. In those in whom cough developed, a second and then a third ACE-I were tried. Cough developed in 50 (18.6%) of the 268 patients; 23 patients with hypertension (14%) had coughs 24.7 +/- 17.1 (SD) weeks after initiation of therapy; 27 patients with CHF (26%) had coughs 12.3 +/- 12 (SD) weeks after the start of ACE-I therapy (P = 0.005). All but three patients had coughs also on the second and third ACE-I. The time from the beginning of therapy to the onset of cough was significantly shorter with the second than the first drug. ACE-I agents had to be discontinued in 50% of the patients in whom coughs developed, most of them in the CHF group. In the others, cough was well tolerated or disappeared during subsequent months. The incidence of cough, which necessitated discontinuation of ACE-I treatment, was 4% among patients with hypertension and 18% among patients with CHF (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

PMID 7876404  J Clin Pharmacol. 1994 Nov;34(11):1116-20.
著者: Akio Niimi, Yasuki Kihara, Yoshiyuki Sumita, Yoshiaki Okano, Keiichi Tambara, Masatoshi Fujita
雑誌名: Int Heart J. 2005 Sep;46(5):923-6. doi: 10.1536/ihj.46.923.
Abstract/Text A 72-year-old man was referred for further assessment of a chronic cough. He noticed an association between the episodes of coughing and palpitations. Electrocardiography (ECG) revealed normal sinus rhythm and sporadic unifocal ventricular premature contractions (VPCs). Each cough was preceded by a premature beat. Continuous wave Doppler echocardiography revealed a VPC-induced transient increase in the pulmonary artery blood flow. He was successfully treated for VPCs with oral disopyramide, resulting in subsidence of both the coughing and palpitations. We suspect that the VPC-induced hemodynamic changes in the pulmonary circulation might be responsible for coughing in our patient. Premature contractions should be considered as a possible cause of chronic dry cough in the clinical setting.

PMID 16272784  Int Heart J. 2005 Sep;46(5):923-6. doi: 10.1536/ihj.46.・・・

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