Predictors of Airway Intervention in Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema.

OBJECTIVES: 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. STUDY
DESIGN: Case series with chart review.
SETTING: Three university tertiary care hospitals. SUBJECTS AND 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).
CONCLUSION: 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. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.