Patients with Asthma More Likely to Switch from ACEI to ARB

Pavankumar Kamat


May 21, 2021


  • Patients with asthma had an increased risk of switching from angiotensin-converting enzyme inhibitors (ACEI) to angiotensin receptor blockers (ARB) therapy and the risk was greatest in those with more severe asthma.

  • The risk of switching differed by age, sex, body mass index (BMI) and British Thoracic Society (BTS) step.

Why this matters

  • Findings suggest that ARB may be considered first-line in older patients with asthma or young patients with more severe asthma including those with other high-risk characteristics.

Study design

  • A population-based cohort study of 642,336 new users of ACEIs from the UK Clinical Practice Research Datalink (1998-2014).

  • The risk of switching from ACEI to ARB in patients with asthma, chronic obstructive pulmonary disease (COPD) and the general population was compared.

  • Funding: None.

Key results

  • Of 642,336 new users of ACEI, 40,953 (6.4%) had active asthma.

  • Overall, 7108 (17.4%) of patients with asthma switched to ARB following ACEI initiation vs 88,980 (14.8%) from the general population.

  • The risk of switching to ARB was higher in (adjusted HR [aHR]; 95% CI):

    • patients with asthma (1.16; 1.14-1.18; P<.001); and

    • those aged ≥60 years (1.35; 1.32-1.39) and <60 years (1.18; 1.15-1.22; P<.001 for both) at BTS step ≥3.

  • The risk was higher with enalapril (aHR, 1.25; 95% CI, 1.18-1.34) and greater in those at BTS step ≥3 (aHR, 1.44; 1.32-1.58; P<.001 for both).

  • No increased risk of switching to ARBs was observed in patients with COPD and those with asthma aged >60 years at BTS step 1/2.

  • The number needed to treat with ACEI for one person to switch an ARB varied by age, sex, and BMI ranging from 21 to 4, being lower in older women with a BMI of ≥25 at BTS step 3.


  • Risk of unmeasured confounding.


Morales DR, Lipworth BJ, Donnan PT, Wang H. Intolerance to angiotensin converting enzyme inhibitors in asthma and the general population: a UK population-based cohort study. J Allergy Clin Immunol Pract. 2021 May 06 [Epub ahead of print]. doi: 10.1016/j.jaip.2021.04.055. PMID: 33965593.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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