lisinopril and Dyspnea

Chemoradiation (CRT) is an integral treatment modality for patients with locally advanced lung cancer. It has been hypothesized that current use of an angiotensin-converting enzyme inhibitor during CRT may be protective for treatment-related lung damage and pneumonitis.. We conducted a pilot, double-blind, placebo-controlled, randomized trial. Study-eligible patients receiving curative thoracic radiation therapy (RT) were randomly assigned to 20 mg of lisinopril or placebo once daily during and up to 3 months after RT. All patients received concurrent chemotherapy. The primary endpoint was adverse event profiling. Multiple patient-reported outcome (PRO) surveys, including the Lung Cancer Symptom Scale, Function Assessment of Cancer Therapy-Lung, and the European Organisation for Research and Treatment of Cancer Lung Cancer Questionnaire, were applied with a symptom experience questionnaire. Exploratory comparative statistics were used to detect differences between arms with χ. Five institutions enrolled 23 patients. However, accrual was less than expected. Eleven and 12 patients were in the placebo and lisinopril arms, respectively (mean age, 63.5 years; male, 62%). Baseline characteristics were balanced. Eighteen patients (86%) were former or current smokers. The primary endpoint was met; neither arm had grade 3 or higher hypotension, acute kidney injury, allergic reaction (medication-induced cough), or anaphylaxis (medication-related angioedema). Few PRO measures suggested that compared with the placebo arm, patients receiving lisinopril had less cough, less shortness of breath, fewer symptoms from lung cancer, less dyspnea with both walking and climbing stairs, and better overall quality of life (for all, P < .05).. Although underpowered because of low accrual, our results suggest that there was a clinical signal for safety-and possibly beneficial by limited PRO measures-in concurrently administering lisinopril during thoracic CRT to mitigate or prevent RT-induced pulmonary distress. Our results showed that a definitive, larger-scale, randomized phase 3 trial is needed in the future.

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Chemoradiotherapy; Double-Blind Method; Dyspnea; Female; Humans; Lisinopril; Lung; Lung Neoplasms; Male; Middle Aged; Patient Safety; Pilot Projects; Placebos; Quality of Life; Radiation Injuries; Radiation Pneumonitis; Radiotherapy; Surveys and Questionnaires; Treatment Outcome

A multicenter, randomized, double-blind assessment of 130 patients with congestive heart failure (New York Heart Association functional classes II to IV) was undertaken to assess the therapeutic efficacy of lisinopril, an angiotensin-converting enzyme inhibitor. All the subjects received concurrent therapy with digoxin and diuretics. Assessments performed periodically over 12 weeks revealed that the active treatment was associated with significant improvements in treadmill exercise time, cardiothoracic ratio, ejection fraction, functional status and clinical signs and symptoms of heart failure. Lisinopril exhibited a mild first-dose effect on blood pressure that was not significantly different from that observed with placebo. The incidence of adverse experiences was not markedly different in the 2 study groups, with only mild hypotension and dizziness occurring more frequently in association with the active medication.

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiac Output; Clinical Trials as Topic; Double-Blind Method; Dyspnea; Enalapril; Exercise Test; Fatigue; Heart Failure; Humans; Lisinopril; Multicenter Studies as Topic; Placebos; Random Allocation; Time Factors

Topics: Cardiomyopathies; Carvedilol; Coronary Artery Disease; Dyspnea; Furosemide; Heart Failure; Heart Ventricles; Humans; Lisinopril; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive

► Dyspnea ► Lower extremity edema ► Limitations in daily activities.

Topics: Activities of Daily Living; Aged, 80 and over; Diagnosis, Differential; Diuretics; Dyspnea; Edema; Female; Heart Failure; Humans; Lisinopril; Lower Extremity; Metoprolol; Obesity; Spironolactone; Torsemide

Topics: Adult; Antihypertensive Agents; Aspirin; Chest Pain; Coronary Vasospasm; Dyspnea; Humans; Lisinopril; Male; Marijuana Smoking; Metoprolol; Muscle Tonus; Rivaroxaban; Tobacco Smoking; Treatment Outcome; Young Adult

Topics: Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Aged; Angiography; Angiotensin-Converting Enzyme Inhibitors; Atorvastatin; Carbazoles; Cardiomyopathy, Dilated; Carvedilol; Clopidogrel; Diuretics; Dyspnea; Echocardiography; Electrocardiography; Furosemide; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lisinopril; Male; Mineralocorticoid Receptor Antagonists; Platelet Aggregation Inhibitors; Potassium; Propanolamines; Pyrroles; Spironolactone; Ticlopidine

The evaluation of dyspnea most often leads to a cardiac or pulmonary diagnosis. In the elderly, however, the cause is commonly multifactorial. The emergency physician should always consider noncardiopulmonary etiologies when treating such patients. We present 2 cases of new-onset type IV renal tubular acidosis (RTA) in older patients taking lisinopril who presented to the emergency department as dyspnea. Both patients had chronic cardiopulmonary illnesses and were initially diagnosed as having either congestive heart failure, asthma exacerbations, or both. The laboratory results for RTA are specific and the diagnosis can be made in the ED.

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Dyspnea; Female; Humans; Hypoaldosteronism; Lisinopril; 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

A new clinical index of dyspnea and fatigue has been applied to rate the condition of patients with congestive heart failure. The index has 3 components, each rated on a scale from 0 to 4, for the magnitude of the task that evokes dyspnea or fatigue, the magnitude of the pace (or effort) with which the task is performed and the associated functional impairment in general activities. The ratings for each component are added to form an aggregated score, which can range from 0, for the worst condition, to 12, for the best. Because dyspnea and fatigue are prime symptoms and sources of clinical distress, the index helps reflect the quality of life in patients with congestive heart failure. In double-blind trials of therapy, changes in the index showed good correlations with patients' self-selected ratings of improvement. The posttherapeutic changes in the index ratings were significantly higher with a new active agent (lisinopril) than with placebo or another active agent (captopril).

Topics: Angiotensin-Converting Enzyme Inhibitors; Captopril; Double-Blind Method; Dyspnea; Enalapril; Fatigue; Heart Failure; Humans; Lisinopril; Quality of Life; Random Allocation