A case of airway compromise

ACE inhibitors have long been recognised to cause angio-oedema 1 -incidence is 0.1-0.7% in patients treated with these drugs. 2 3 4 5 With increasing indication and widespread use, these drugs are a common cause of isolated angio-oedema in emergency departments. 6 7 ACE inhibitors prevent the conver...

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Bibliographic Details
Published in:BMJ 2010-09, Vol.341 (sep29 1), p.c3822-c3822
Main Authors: Hussain, Nehal, Ahmed, Noweed, Ramjug, Sheila
Format: Article
Language:English
Subjects:
ACE inhibitors
Aged
Airway Obstruction - chemically induced
Angioedema - chemically induced
Angioedema - prevention & control
Angioedema - therapy
Angiotensin I
Angiotensin II
Angiotensin-converting enzyme inhibitors
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Asthma
Bradykinin
Case reports
Diuretics
Drug dosages
Edema
Enzymes
Family medical history
Humans
Larynx
Lisinopril - adverse effects
Male
Patients
Respiratory tract
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Summary:ACE inhibitors have long been recognised to cause angio-oedema 1 -incidence is 0.1-0.7% in patients treated with these drugs. 2 3 4 5 With increasing indication and widespread use, these drugs are a common cause of isolated angio-oedema in emergency departments. 6 7 ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor, but they also inhibit the degradation of bradykinin, a vasodilator. The treatment of ACE inhibitor induced angio-oedema requires discontinuation of the drug, with careful airway management until symptoms resolve. Newer evidence shows that fresh frozen plasma can be used treat ACE inhibitor induced angio-oedema when it proves to be resistant to other measures. 13 Patients should be observed on a high dependency unit or a ward that is familiar with observing patients with airway compromise. Long answer Angio-oedema induced by an ACE inhibitor is often missed because it can occur years after the patient starts the treatment and can recur if treatment is continued. 3 14 15 Angio-oedema can occur within 48 hours of treatment, 2 although one study of 64 consecutive cases over a nine year period found that the median length of treatment before an episode was 12 months, with the longest being 156 months. 16 The main distinguishing clinical features were old age and the absence of an allergic history, as seen in our case. A fourfold increase in the risk of ACE inhibitor induced angio-oedema has been reported in black American patients, which suggests that these patients...
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.c3822