PMID- 15302724
OWN - NLM
STAT- MEDLINE
DCOM- 20040903
LR  - 20221207
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 126
IP  - 2
DP  - 2004 Aug
TI  - Airway compromise due to angiotensin-converting enzyme inhibitor-induced 
      angioedema: clinical experience at a large community teaching hospital.
PG  - 400-4
AB  - STUDY OBJECTIVE: To evaluate the incidence of airway compromise, clinical 
      presentation and morbidity of angiotensin-converting enzyme inhibitor 
      (ACEI)-related angioedema (AE). METHOD: A retrospective chart review was 
      conducted of all patients admitted to our hospital between 1996 and 2001 with the 
      diagnosis of AE. RESULTS: A total of 70 charts on which a diagnosis of AE had 
      been entered were reviewed. Of those, 45 patients (64%) had AE that was thought 
      to be related to ACEI therapy. Of those 45 patients, 29 were women. The mean age 
      was 62 years, and 41 (91%) were African-American. The duration of ACEI therapy 
      before presentation varied from 1 day to 5 years postingestion. Twenty-one of 32 
      patients presented within 2 months of the initiation of therapy. The mean 
      duration between the onset of symptoms and presentation to the hospital was 9 h. 
      Lip and tongue swelling was seen in all patients. Pulmonary manifestations were 
      noted in 17 of 45 patients (38%) [dyspnea 17 of 17 patients; stridor/respiratory 
      failure, 5 of 17 patients; cough, 2 of 17 patients]. Dysphagia was noted in 9 of 
      45 patients, drooling of saliva in 8 of 45 patients, and pruritus in 6 of 45 
      patients. Ten of 45 patients had a history of AE. In five of those patients 
      (50%), ACEI use was a presumed cause of the AE for the current hospital 
      admission. Eighteen of 45 (40%) patients required ICU admission. The mean ICU 
      length of stay was 2.2 days. Five of 45 patients required endotracheal 
      intubation. The mean time spent receiving ventilation was 2.2 days. 
      Discontinuation of the initiating agent and supportive care were the keys to 
      therapy. All of our patients responded to supportive management, and there was no 
      mortality. CONCLUSION: Sixty-four percent of patients in this series had AE due 
      to receiving an ACEI. The majority of the patients were African-American women. 
      Most patients presented within 2 months of starting to receive the drug, although 
      longer durations of therapy were not uncommon. Lip and tongue swelling was the 
      most common airway manifestation. Based on our observations, the discontinuation 
      of ACEI therapy and supportive management are the recommended approaches to 
      therapy to prevent an untoward outcome.
FAU - Sondhi, Damanpaul
AU  - Sondhi D
AD  - Division of Pulmonary and Critical Care, Albert Einstein Medical Center, Klein 
      Building, Suite 363, 5401 Old York Rd, Philadelphia, PA 19141, USA. 
      lippmanm@einstein.edu
FAU - Lippmann, Michael
AU  - Lippmann M
FAU - Murali, Ganesan
AU  - Murali G
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
MH  - Black or African American
MH  - Angioedema/*chemically induced/*complications/pathology/therapy
MH  - Angiotensin-Converting Enzyme Inhibitors/*adverse effects
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Intubation, Intratracheal
MH  - Length of Stay
MH  - Lip/pathology
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Tongue/pathology
EDAT- 2004/08/11 05:00
MHDA- 2004/09/04 05:00
CRDT- 2004/08/11 05:00
PHST- 2004/08/11 05:00 [pubmed]
PHST- 2004/09/04 05:00 [medline]
PHST- 2004/08/11 05:00 [entrez]
AID - S0012-3692(15)31150-8 [pii]
AID - 10.1378/chest.126.2.400 [doi]
PST - ppublish
SO  - Chest. 2004 Aug;126(2):400-4. doi: 10.1378/chest.126.2.400.