title: Predictors of Airway Intervention in Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema.
abstract: OBJECTIVE
  Identify factors associated with angiotensin-converting enzyme inhibitor-induced angioedema (AIIA), including (1) time of presentation, (2) clinical symptoms, and (3) anatomical regions in the head and neck, that may indicate need for airway intervention.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Three university tertiary care hospitals.
  
  
  METHODS
  Medical records of adult patients presenting to the emergency department (ED) diagnosed with AIIA within a 3-year period were reviewed. Time at presentation, presenting symptoms, physical examination findings, treatment, length of hospitalization, and outcomes were examined. Univariate analysis was performed.
  
  
  RESULTS
  311 patients were diagnosed with AIIA and evaluated with flexible laryngoscopy by an otolaryngologist. Patients requiring airway intervention most often presented within 4 hours of onset. Dysphagia, dysphonia, drooling, respiratory distress, and globus sensation were associated with airway intervention (χ(2) range, 9.1-47.1). Patients with edema of the face, lower lip, and upper lip were at low risk for airway intervention (odds ratio = 0.4, 0.3, and 0.4, respectively; all P values <.05), while those with involvement of the tongue, soft palate, vallecula, aryepiglottic folds, and true vocal cords were associated with highest risk (odds ratio = 11.1, 12.3, 9.9, 8.5, and 33.5, respectively; all P values < .001).
  
  
  CONCLUSIONS
  This is the largest patient series to date of AIIA patients evaluated with flexible laryngoscopy. Physicians should be aware of certain risk factors that will require a higher acuity level of care, including (1) presentation within 4 hours of symptom onset, (2) symptoms such as drooling and respiratory distress, (3) and involvement of the tongue, soft palate, and larynx.
authors.affiliation: Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, USA Michigan State University, East Lansing, Michigan, USA mkieu@dmc.org.
authors.forename: Monica Chau Q
authors.initials: MC
authors.lastname: Kieu
authors.affiliation: Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, USA Michigan State University, East Lansing, Michigan, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Bangiyev
authors.affiliation: Department of Otolaryngology, Detroit Medical Center, Detroit, Michigan, USA Michigan State University, East Lansing, Michigan, USA.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: Department of Emergency Medicine, Detroit Receiving Hospital, Detroit, Michigan, USA Wayne State University, Detroit, Michigan, USA.
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levy
mesh_terms: D001741:Black or African American; D058109:Airway Management; D000799:Angioedema / Q000139:chemically induced* / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D014139:Tracheostomy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: allergic reaction; angioedema; angiotensin-converting enzyme inhibitor; tracheostomy