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Cough Related to Angiotensin-Converting Enzyme Inhibition-Reply

Louis-Philippe Boulet, MD; Joanne Milot, BSc; Noël Lampron, MD; Yves Lacourcière, MD
JAMA. 1989;262(1):29-30. doi:10.1001/jama.1989.03430010041015.
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In Reply. —  We thank Dr Levy for his comments. Our study addressed the following question: Is captopril-related cough associated with the development of airflow obstruction or airway hyper-responsiveness? Our observations show that this is not the case. We determined airway responsiveness using the response to inhaled methacholine. We prefer to use methacholine inhalation tests because they are among the best standardized methods of measurement of nonallergic airway responsiveness and because the degree of response to histamine/methacholine tests is closely correlated to the presence of variable airflow obstruction, the severity of asthma symptoms, and medication needs.1 Furthermore, a direct relationship has been established between the degree of bronchial response to many chemical or physical nonallergic stimuli and methacholine/histamine.As we mentioned in our article, 3 of 15 subjects had a mild reduction in the provocative concentration of methacholine that resulted in a 20% fall in forced expiratory volume in


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