Increasing rate of angiotensin-converting enzyme inhibitor-related upper airway angio-oedema

The objective of this study was to evaluate whether the increased use of angiotensin-converting enzyme inhibitors (ACEI) has affected the rate of upper airway angio-oedema (AE). In addition, we evaluated the presentation and treatment of patients with upper airway AE.

This was a ten-year retrospective study of 112 patients presenting with upper airway AE at The Department of Otorhinolaryngology, Aarhus University Hospital, Denmark. Incidence, presentation and treatment in the 2000-2004-period were compared to those of the 2005-2009-period.

In the ten-year period, we found 112 AE patients of whom 39% were using ACEI. The relative risk of AE was 7.7 (p < 0.0001) among ACEI users. We found a 67% increase in AE in 2005-2009 compared with 2000-2004 which corresponds to a similar increase in ACEI use in the Danish population. The most frequent anatomic sites of involvement were the floor of the mouth and/or oropharynx including the base of the tongue. Two patients required intubation upon their arrival to the hospital. None progressed in airway obstruction requiring intubation later. None died.

We found an increasing rate of ACEI-related upper airway AE over a ten-year period corresponding to greater use of ACEI in the population. With a relative risk of 7.7 and continuously increasing ACEI consumption, this condition will certainly require future attention and resources as almost one third of patients are admitted to an intensive care unit.