ACE inhibitor cough — SCE Respiratory MCQ

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HardCoughACE inhibitor coughSCE Respiratory

A 50-year-old non-smoker has chronic dry cough for 18 months. CXR and spirometry are normal, FeNO is low and reflux treatment has not helped. He started ramipril 2 months before symptoms began. What is the most likely underlying cause?

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Correct answer: C — ACE inhibitor-related cough

The best answer is “ACE inhibitor-related cough”. The clinical pattern, physiology and imaging described are most consistent with ACE inhibitor-related cough. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Obesity hypoventilation syndrome”, “Cough-variant asthma, after specialist assessment”, “Pulmonary tuberculosis, with clinical reassessment”, “Idiopathic pulmonary fibrosis”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: BTS/NICE/SIGN asthma guideline NG245: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations