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From the authors

Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.

I would like to thank S. Teramoto and co-workers for their response to the study my co-workers and I performed on the effects of angiotensin-converting enzyme (ACE) inhibitors on the risk of acquiring pneumonia. Indeed, we could not confirm an association between the use of ACE inhibitors and the risk of pneumonia in a general population. This, however, does not exclude any beneficial effects of ACE inhibitors in specified patient subgroups.

As mentioned in our introduction and by S. Teramoto and co-workers, it is known that patients with a history of stroke do have a higher risk of acquiring pneumonia, which is particularly due to a reduced cough and swallowing reflex 1, 2. That ACE inhibitors can be beneficial in these patients is already widely reported 3–5. We aimed to study whether this protective effect can also be extended to the general population. Unfortunately, we were not able to test modification of the association through stroke, as data on stroke history were sparsely available in the database.

Concerning ethnicity, the reason why the association could not be confirmed in the non-Asian participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) is still subject to speculation. Genetic differences should certainly be considered. However, Ohkubo et al. 4 were unable to show an influence of the ACE I/D polymorphism on the protective association. Another explanation could be the higher prevalence of ACE inhibitor-induced cough in Chinese subjects, as shown by Chan et al. 6. It is possible that ACE inhibitors are also protective in non-Asian populations. However, larger populations may be necessary to confirm such an effect.

Further studies on the relationship between angiotensin-converting enzyme and pneumonia in predominantly white populations are currently being undertaken in our department.

REFERENCES

1. Sekizawa K, Ujiie Y, Itabashi S, Sasaki H, Takishima T. Lack of cough reflex in aspiration pneumonia. Lancet 1990;335:1228–1229.[ISI][Medline] [Order article via Infotrieve]
2. Nakagawa T, Sekizawa K, Arai H, et al. High incidence of pneumonia in elderly patients with basal ganglia infarction. Arch Intern Med 1997;157:321–324.[Abstract]
3. Arai T, Yasuda Y, Toshima S, Yoshimi N, Kashiki Y. ACE inhibitors and pneumonia in elderly people. Lancet 1998;352:1937–1938.[ISI][Medline] [Order article via Infotrieve]
4. Ohkubo T, Chapman N, Neal B, et al. Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk. Am J Respir Crit Care Med 2004;169:1041–1045.[Abstract/Free Full Text]
5. Arai T, Sekizawa K, Ohrui T, et al. ACE inhibitors and protection against pneumonia in elderly patients with stroke. Neurology 2005;64:573–574.[Free Full Text]
6. Chan WK, Chan TY, Luk WK, et al. A high incidence of cough in Chinese subjects treated with angiotensin converting enzyme inhibitors. Eur J Clin Pharmacol 1993;44:299–300.[CrossRef][ISI][Medline] [Order article via Infotrieve]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by van de Garde, E. M. W. Search for Related Content PubMed Articles by van de Garde, E. M. W.