imidapril and Airway-Obstruction

Although angiotensin-converting enzyme (ACE) inhibitors are widely used as the first choice drug for treating hypertension, we have only a superficial understanding of their relationship to angioedema. We report a case of life-threatening angioedema. The case was a 60-year-old man who had been taking an ACE inhibitor for hypertension for 11 years. He visited his home doctor for dyspnea, and tongue and neck swelling. He was transported to our hospital because of the possibility of airway obstruction. On admission, his tongue and neck swelling became more severe. We performed an intubation using an endoscope and started airway management. We also stopped his ACE inhibitor. The severe tongue and neck swelling improved gradually and he was extubated on day 3. On the fifth day he was discharged. We diagnosed angioedema caused by an ACE inhibitor. Although the risk of airway obstruction with ACE inhibitors is acknowledged, we have only a superficial understanding of how prolonged ACE inhibitor treatment induces angioedema. So we should consider angioedema in cases of taking ACE inhibitors, especially in cases of prolonged treatment.

Topics: Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Humans; Imidazolidines; Male; Middle Aged; Severity of Illness Index; Time Factors; Treatment Outcome; Withholding Treatment

Angioedema due to angiotensin-converting enzyme inhibitors (ACEIs) therapy occurs not infrequently and is sometimes associated with life-threatening conditions.. A 59-year-old woman presented with recurrent angioedema of the tongue complicated by upper airway obstruction which required endotracheal intubation. Laboratory tests including complement levels were normal. ACEI-associated angioedema precipitated by NSAIDs was suspected. Her condition improved after discontinuation of imidapril and diclofenac without other specific treatment.. ACEIs, and in particular concomitant use with NSAIDs, should be avoided in patients with a history of angioedema because continuing administration tends to lead to more severe attacks.

Topics: Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Diabetes Mellitus, Type 2; Diclofenac; Drug Therapy, Combination; Female; Humans; Imidazolidines; Intubation, Intratracheal; Middle Aged; Pain; Withholding Treatment