Delay of diagnosis and empiric treatment of angiotensin-converting enzyme inhibitor-induced cough in office practice.

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.