enalapril and Asthma

Twenty-one subjects with known bronchial hyperreactivity were prospectively randomized in double-blind fashion to receive one of two angiotensin-converting enzyme inhibitors (ACE-I), enalapril or spirapril, for three weeks. Spirometry and methacholine provocation were performed prior to, during, and following ACE-I usage. Three of 21 subjects developed a nonproductive cough. However, only one subject wheezed slightly. Spirometry and bronchial reactivity (PD20) were unchanged throughout the study.

Topics: Adolescent; Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchial Hyperreactivity; Bronchial Provocation Tests; Cough; Double-Blind Method; Drug Tolerance; Enalapril; Female; Humans; Male; Methacholine Chloride; Middle Aged; Prospective Studies; Single-Blind Method

To evaluate peculiarities and trends in 24-hour arterial pressure (AP) profile and bronchoobstructive syndrome (BOS) in patients with chronic obstructive pulmonary diseases (COPD) and arterial hypertension (AH) on combined treatment including enalapril maleate.. Changes in BOS as shown by clinical data, data of peakflowmetry and external respiration function as well as in AP 24-hour profile according to 24-hour monitoring were studied in 50 patients with exacerbation of bronchial asthma and chronic bronchitis treated for 4 weeks with conventional broncholytic and antiinflammatory modalities, in 28 patients with mild and moderate AH receiving combined therapy including enalapril maleate.. In exacerbation of COPD, 24-h AP profile is characterized by high frequency of the curve "non-dipper". Concomitant mild and moderate AH was diagnosed in more than half of the examinees. The addition of enalaprile maleate to the treatment in many cases lowered systolic and diastolic AP, normalized sympathicoadrenal system and 24-hour AP rhythm, reduced dyspnea, improved exercise tolerance, sleep. Good tolerance of the drug was seen in patients with exacerbation of COPD.. In exacerbation of COPD it is recommended to monitor AP for 24 hours for early detection of AH and initiation of combined treatment with correction of bronchoobstructive syndrome and hemodynamic disorders. As a hypotensive drug, enalapril maleate is adequate in such patients.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Asthma; Blood Pressure; Bronchitis, Chronic; Chronic Disease; Circadian Rhythm; Enalapril; Female; Humans; Hypertension; Lung Diseases, Obstructive; Male; Middle Aged

The Churg-Strauss syndrome is characterised by a history of asthma and paranasal sinus disease, eosinophilia of more than 10 per cent, non-fixed pulmonary infiltrates on chest radiography and vasculitis which may affect multiple organ systems. The condition usually manifests in the 4th decade. We present a 21-year old female with a history of asthma since one year of age who developed symptoms and signs of pneumonia, a pulmonary infiltrate on chest radiography and eosinophilia. This was followed a few weeks later by vasculitis which affected the skin and myocardium and associated with a peripheral eosinophilia of more than 80%. Physical examination revealed palpable purpura and signs of left ventricular failure. Echocardiography confirmed significant diminution of left ventricular contractility. A rapid improvement was observed after steroid therapy. Echocardiography after two months showed normal left ventricular function. In this presentation we review the cardiac manifestations of the Churg-Strauss syndrome and its management.

Topics: Adult; Asthma; Churg-Strauss Syndrome; Electrocardiography; Enalapril; Female; Furosemide; Heart Diseases; Humans; Immunosuppressive Agents; Ventricular Function, Left

Topics: Asthma; Bronchitis; Enalapril; Female; Humans; Hypertension; Middle Aged

To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors.. Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised.. Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions.. Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea.. In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors.. Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchial Spasm; Captopril; Cough; Dyspnea; Enalapril; Female; Humans; Lisinopril; Male; Middle Aged; Ramipril

To assess the effects of enalapril on bronchial responsiveness, we studied ten stable asthmatics and five healthy normal volunteers. Spirometry and methacholine bronchoprovocation dose (PC20) were measured before and after oral administration of 20 mg enalapril. Significant hypotensive effect was observed in all. More than two fold (2.73) increase in bronchial responsiveness was observed in the asthmatics (P < 0.01) without significant change in the expiratory flows. PC20 after enalapril fell by 56.8 +/- 23.0% of baseline value (P < 0.001). No significant change was observed in spirometric parameters and bronchial responsiveness in normal subjects. We conclude that enalapril significantly enhances BR and cannot be used safely in treatment of hypertension in asthmatics.

Topics: Adult; Asthma; Bronchi; Bronchial Provocation Tests; Enalapril; Humans; Methacholine Compounds; Respiratory Function Tests; Spirometry

Seventeen patients using angiotensin-converting enzyme (ACE) inhibitors for hypertension were evaluated with baseline spirometry followed by determination of bronchial reactivity by challenge with methacholine. There were nine coughers and eight noncoughers in the study. Among the nine coughers, eight demonstrated bronchial hyperreactivity. Conversely, none of the noncoughers disclosed bronchial hyperreactivity. Eight of the nine coughers were rechallenged two to six months following cessation of ACE inhibitor therapy. Six of these eight showed persistent bronchial hyperreactivity. We conclude that cough is associated with the use of ACE inhibitors in patients with underlying bronchial hyperreactivity. The findings indicate caution in administration of ACE inhibitors in asthmatic patients and those with known bronchial hyperreactivity.

Topics: Asthma; Bronchi; Bronchial Provocation Tests; Captopril; Cough; Enalapril; Female; Humans; Hypertension; Male; Maximal Expiratory Flow Rate; Methacholine Chloride; Methacholine Compounds; Middle Aged; Spirometry; Vital Capacity

Angiotensin converting enzyme inhibitors cause cough in some patients, but the mechanism of this effect is not known. Six patients in whom these inhibitors had caused cough and a further two patients in whom they were suspected to have caused worsening of bronchial asthma were studied. Nine patients in whom angiotensin converting enzyme inhibitors had not been associated with cough served as controls. In the controls lung function and bronchial reactivity were measured once; for the study patients these and the cough index were measured twice before rechallenge for two weeks with an angiotensin enzyme inhibitor and once afterwards. Rechallenge with drug for two weeks caused a significant decrease in the mean concentration of histamine causing a 35% fall in airways conductance and a significant increase in the cough index. Patients with cough showed bronchial hyperactivity compared with the controls, which increased after rechallenge with the inhibitors. Cough associated with converting enzyme inhibitors may be a variant of the cough in asthma.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchi; Bronchial Provocation Tests; Captopril; Cough; Enalapril; Female; Histamine; Humans; Hypertension; Male; Middle Aged

Topics: Adult; Aged; Asthma; Captopril; Cough; Enalapril; Female; Humans; Hypertension; Male; Middle Aged; Prospective Studies

Topics: Asthma; Captopril; Cough; Enalapril; Humans; Respiratory Sounds