enalapril and Airway-Obstruction

Angioedema of the face and neck is a rare but potentially fatal complication of angiotensin-converting enzyme inhibitor (ACEI) use. We retrospectively reviewed five cases of ACEI angioedema seen at our institution over the past 2 1/2 years. Four of the cases occurred with enalapril and one with lisinopril. Onset of symptoms varied from two days to ten months. Importantly, three of the five patients had been receiving medication three months or longer, suggesting clinicians must consider this complication during long-term administration of these agents. Three of the five patients were markedly obese, had a history of previous face and neck surgery, or had been intubated in the past. Thus, we propose that previous manipulation or trauma of the upper airway, perhaps resulting in airway narrowing, may represent a risk factor for upper airway obstruction secondary to ACEI-induced angioedema.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Causality; Dipeptides; Enalapril; Female; Humans; Lisinopril; Male; Middle Aged; Obesity; Retrospective Studies; Time Factors

Topics: Aged; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Diagnosis, Differential; Drug Combinations; Drug Hypersensitivity; Dyspnea; Enalapril; Heart Arrest; Humans; Hydrochlorothiazide; Male; Tongue Diseases

Angio-oedema are often massive but temporary swellings of the soft tissue of the face or the throat, which can also affect other regions of the human body (e.g. the skin or internal organs). An oedema of the face and throat represents a life-threatening situation. Apart from the clinical condition of the patient and detailed knowledge of the medical history (incl. medical applications), the treatment should depend on the different pathogenesis. In this reported case, we describe the severe clinical development of an angio-oedema under a long-term treatment with an ACE-inhibitor, which in the end was only successfully treated with the application of a C1 inhibitor concentrate.

Topics: Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Complement C1 Inactivator Proteins; Critical Care; Drug Therapy, Combination; Enalapril; Female; Humans; Hypertension; Middle Aged; Risk Factors; Tongue Diseases

Inhibitors of angiotensin converting enzyme may rarely cause an angioneurotic oedema of the upper aerodigestive tract. The pathomechanism of this side effect depends on an interaction of the drug with hormones regulating the vascular resistance such as the kallikrein kinin system and the prostaglandin system. Anglo-oedema is characterised by subcutaneous or submucosal swelling, which preferably affects the lips, the soft palate, the tongue and the larynx. Pathomechanisms, differential diagnosis and treatment of ACE-inhibitor induced oedema of the upper aerodigestive tract are described by means of 3 case reports.

Topics: Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Deglutition Disorders; Enalapril; Humans; Hypertension; Lisinopril; Male; Middle Aged

Topics: Airway Obstruction; Angioedema; Emergencies; Enalapril; Female; Humans; Hypertension; Middle Aged; Osteoarthritis; Time Factors; Tongue Diseases

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Dexamethasone; Dipeptides; Diphenhydramine; Enalapril; Epinephrine; Female; Humans; Injections, Intravenous; Laryngeal Edema; Lisinopril; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Prognosis

Angiotensin-converting enzyme (ACE) inhibitors have several side effects of concern to the otolaryngologist. Angioedema is a rare, but potentially lethal adverse effect when associated with upper airway obstruction. Four cases of ACE-inhibitor-induced angioedema, three with significant upper airway obstruction, are reported. Angioedema secondary to ACE inhibition appears to be mechanism based. The probable link is the potentiation of bradykinin, which results in vasodilation, increased vascular permeability, and angioedema. Since angioedema can progress to upper airway obstruction, otolaryngologists must be aware of this association. The differential diagnosis and treatment of this adverse effect is discussed, as well as a review of ACE inhibitors and other causes of angioedema.

Topics: Adult; Airway Obstruction; Angioedema; Captopril; Enalapril; Female; Humans; Male; Middle Aged; Tongue Diseases

A report of three patients who developed angiodema while receiving enalapril. Patient 1 came in with an 8-hour history of facial swelling after enalapril had been started 2 days earlier. The second patient came in with severe angiodema of the tongue, larynx, and glottis requiring emergency tracheostomy, hydroxyzine, and steroids. He had been treated with enalapril for 1 year. The third patient developed facial swelling within a few hours of the first dose of enalapril. Angiodema with enalapril can occur early or late in the course of therapy. A possible mechanism for this drug reaction is the potentiation of bradykinin with resultant kinin system activation.

Topics: Aged; Airway Obstruction; Angioedema; Diphenhydramine; Enalapril; Humans; Hypertension; Male; Middle Aged; Tracheostomy

Topics: Airway Obstruction; Angioedema; Captopril; Enalapril; Humans; Tracheotomy

Angioedema that occurs in the head and neck may be a serious and possibly life-threatening condition. We present two cases of oropharyngeal angioedema associated with the use of angiotensin-converting enzyme inhibitors in patients with no underlying renal failure. Angiotensin-converting enzyme-inhibiting agents are now commonly used to control hypertension. Treatment of acquired angioedema is directed first at protecting the airway by careful observation, intubation, or if necessary, tracheostomy. The causative agent is withdrawn, and the patient is treated with antihistamines and steroids until the acute episode resolves. Although not used in our patients, the treatment of angioedema with subcutaneous epinephrine has been described. As more patients are treated with angiotensin-converting enzyme inhibitors, it becomes essential for the otolaryngologist to become aware of this potentially life-threatening complication.

Topics: Airway Obstruction; Angioedema; Captopril; Enalapril; Female; Humans; Middle Aged; Mouth Diseases; Pharyngeal Diseases

Topics: Airway Obstruction; Enalapril; Female; Humans; Hypertension; Middle Aged; Nose Diseases