title: Comparison of Clinical Factors Between Patients With Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema and Cough.
abstract: BACKGROUND
  Angioedema is a rare and serious adverse drug reaction (ADR) to angiotensin-converting enzyme (ACE) inhibitor treatment. Dry cough is a common side effect of ACE inhibitors and has been identified as a possible risk factor for angioedema.
  
  
  OBJECTIVE
  We compared characteristics between patients with ACE inhibitor-induced angioedema and cough with the aim of identifying risk factors that differ between these adverse events.
  
  
  METHODS
  Data on patients with angioedema or cough induced by ACE inhibitors were collected from the Swedish database of spontaneously reported ADRs or from collaborating clinicians. Wilcoxon rank sum test, Fisher's exact test, and odds ratios (ORs) with 95% CIs were used to test for between-group differences. The significance threshold was set to P <0.00128 to correct for multiple comparisons.
  
  
  RESULTS
  Clinical characteristics were compared between 168 patients with angioedema and 121 with cough only. Smoking and concomitant selective calcium channel blocker treatment were more frequent among patients with angioedema than cough: OR = 4.3, 95% CI = 2.1-8.9, P = 2.2 × 10-5, and OR = 3.7, 95% CI = 2.0-7.0, P = 1.7 × 10-5. Angioedema cases were seen more often in male patients (OR = 2.2, 95% CI = 1.4-3.6, P = 1.3 × 10-4) and had longer time to onset and higher doses than those with cough ( P = 3.2 × 10-10and P = 2.6 × 10-4). A multiple model containing the variables smoking, concurrent calcium channel blocker treatment, male sex, and time to onset accounted for 26% of the variance between the groups.
  
  
  CONCLUSIONS
  Smoking, comedication with selective calcium channel blockers, male sex, and longer treatment time were associated with ACE inhibitor-induced angioedema rather than cough.
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Hallberg
authors.affiliation: 2 The Ryhov County Hospital, Jönköping, Sweden.
authors.forename: Julia
authors.initials: J
authors.lastname: Nagy
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Karawajczyk
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Nordang
authors.affiliation: 3 Skåne University Hospital, Lund, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Islander
authors.affiliation: 4 Sickla Health Centre, Nacka, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Norling
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Johansson
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Mary
authors.initials: M
authors.lastname: Kämpe
authors.affiliation: 5 Örebro University Hospital and Örebro University, Örebro, Sweden.
authors.forename: Svante
authors.initials: S
authors.lastname: Hugosson
authors.affiliation: 6 Medical Products Agency, Uppsala, Sweden.
authors.forename: Qun-Ying
authors.initials: QY
authors.lastname: Yue
authors.affiliation: 1 Uppsala University, Uppsala, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Wadelius
mesh_terms: D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D003371:Cough / Q000139:chemically induced* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013548:Sweden
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers
keywords: ACE inhibitors; adult medicine; adverse drug reactions; calcium-channel blockers; clinical pharmacology; drug safety; interactions; medication safety; pulmonary