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| |  Increase in Angio-oedema Needs to Be Recognised and Treated: Presented at AAO-HNSF By Kristina Rebelo SAN DIEGO -- October 12, 2009 – The use of antihypertensive medications may precipitate angio-oedema, a common disease that needs to be recognised and treated appropriately when patients show up in emergency rooms, according to researchers here at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. In a large series study that evaluated angio-oedema from the years 1997 to 2008, the clinical characteristics of the upper aerodigestive tract and the clinical course of angio-oedema were examined in the charts of 367 patients from 3 tertiary-care hospitals in Brooklyn, New York. Chi-square or Fishers exact test were used to determine the associations that were then confirmed by multiple logistic regression. The study, presented here on October 4, was conducted because of an increasing number of patients with angio-oedema over the past several years; this increase was attributed to the increased use of hypertensive medications. “The typical presentation was that patients would complain of swelling of the mouth or throat and they may have had trouble breathing -- enough to bring them into the emergency department,” said co-investigator Nira A. Goldstein, MD, State University New York (SUNY) Downstate Medical Center, New York, New York. “They may have had hoarseness or stridor and difficulty handling their secretions; there would be oedema of the structures in the mouth and/or throat, involving the face, lips, the oropharynx, and larynx.” The mean patient age in this population was 51.8 years; 66% were female and 62% were African American. Nearly half of the patients were on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) for the treatment of hypertension. A third of patients had a history of allergies, and 22.5% had an inciting factor, such as a change in diet, minor trauma, or exposure to fumes within 48 hours of presentation. Thirty percent of patients had had prior episodes of angio-oedema, while none had been diagnosed with hereditary angio-oedema; 17.2% had angio-oedema involving multiple sites. The study said that in treating the patients, 3.3% were intubated while 0.3% had tracheostomy. Logistic regression identified age, non-African American race, use of ACE/ARB, history of allergies, alcohol use, and multiple affected sites as significant predictors of the need for admission. Bivariate analysis also identified age and multiple affected sites, but additionally indentified presentation with stridor, hoarseness, dysphagia, or drooling as significant predictors of the need for intubation/tracheostomy. Study limitations included the fact that this was a retrospective chart review and the inherent limitations with this type of study design, Dr. Goldstein noted. “A lot of African Americans have hypertension and are being treated with ACE inhibitors or ARBs, and this is a known side effect, but why so many females? We do not yet know,” said Dr. Goldstein, who pointed out that the otolaryngologists were called in to consult in such cases 52% of the time. This means that 48% of patients are being solely treated by emergency-room physicians. “We always have to get involved once the patient has significant airway distress and the patient has to be admitted,” she commented. “The milder cases respond well to intravenous steroids and antihistamines,” Dr. Goldstein added, “and patients can often be discharged once they’re treated, but 58% in our research study were admitted to the hospital, and about 3% of patients need some type of airway intervention, such as intubation or tracheotomy, so it is very serious.” “We see a lot of this in Brooklyn,” Dr. Goldstein noted. “It’s a very common disease, and it needs to be recognised and treated appropriately.” [Presentation title: Angioedema: A Review of 382 Patients Presenting to Three Tertiary Care Hospitals. Abstract SP139]
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