Angiotensin converting enzyme inhibitor cough: Lessons from heart–lung transplantation

Coughing is a frequent side-effect of angiotensin converting enzyme (ACE) inhibitors. Its pathogenesis is thought to be related to the local accumulation of tachykinins although the role of extrinsic cholinergic pathways is unclear. The development of an ACE inhibitor induced cough in two patients who have undergone heart–lung transplantation and in whom cholinergic pathways remain denervated supports the hypothesis of a ‘local’ mechanism.