Pneumotox » Drug » Angiotensin converting enzyme inhibitors (ACEI)

Angiotensin converting enzyme inhibitors (ACEI)

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The spectrum of angiotensin converting enzyme inhibitor-induced problems is huge. Cough and angioedema w/wo UAO are the most typical AE from ACEIs. Upper arway angioedema and closure is the most dreadful one. A few cases were described with ARBs. See under each specific ACEI drug. Icatibant is an effective drug in angioedema cases (PMID: 25646708)

Last update : 23/02/2015

I.b Pneumonitis (ILD)

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

IV.a Bronchospasm - Wheezing - Asthma

1

IV.d Cough (lone)

5

IV.f Severe or catastrophic bronchospasm or asthma attack (can be fatal)

1

IV.g Cough syncope

1

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

1

V.b Eosinophilic pleural effusion

1

V.d Pleural/pericardial effusion, ANA positive (DI lupus)

1

VIII.a Angioedema (may cause UAO, asphyxia and death)

5

VIII.q Tongue involvement (edema, glossitis, hematoma)

3

VIII.y Sinonasal discharge, -blockage, -obstruction

1

VIII.am Hemilingual (angio)edema

1

IX.e Disordered breathing pattern - Cheynes-Stokes respiration

1

IX.q Obstructive sleep apnea

1

X.d Lupus - Lupus syndrome (see also Vd)

1

X.au Visceral angioedema

2

XIII.a Lung cancer

1

XVI.bu Imaging: Upper/central airway narrowing

2

XVIII.f Eye-catcher: Tongue edema

3

Diagnosing DIRD

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Drug and radiation history

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Drug singularity - Correct identification of the drug

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Consistent timing of exposure v. onset of symptoms

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Clinical, imaging, BAL, pathological pattern consistent with the specific drug

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Careful exlusion of another cause

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Remission of symptoms with removal of drug

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Recurrence with rechallenge (rarely advisable)

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Causality assessment

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