title: Predisposition to and late onset of upper airway obstruction following angiotensin-converting enzyme inhibitor therapy.
abstract: 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.
authors.affiliation: Department of Medicine, University of Chicago Hospitals and Clinics.
authors.forename: M
authors.initials: M
authors.lastname: Jain
authors.forename: L
authors.initials: L
authors.lastname: Armstrong
authors.forename: J
authors.initials: J
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology*; D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015984:Causality; D004151:Dipeptides / Q000009:adverse effects; D004656:Enalapril / Q000009:adverse effects; D005260:Female; D006801:Humans; D017706:Lisinopril; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004151:Dipeptides; D004656:Enalapril; D017706:Lisinopril