DYSPNEA, ASTHMA, AND BRONCHOSPASM IN RELATION TO TREATMENT WITH ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS

Objective-To evaluate the occurrence of asthma and dyspnoea precipitat ed or worsened by angiotensin converting enzyme inhibitors. Design-Sum mary of reports of adverse respiratory reaction in relation to treatme nt with angiotensin converting enzyme inhibitors that were submitted t o Swedish Adverse Drug Reactions Advisory Committee and to World Healt h Organisation's international drug information system until 1992. Sal es of angiotensin converting enzyme inhibitors in Sweden were also sum marised. Subjects-Patients receiving angiotensin converting enzyme inh ibitors who reported adverse respiratory reactions. Main outcome measu res-Clinical characteristics of adverse reactions of asthma, bronchosp asm, and dyspnoea. Results-In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patient s had adverse drug reactions diagnosed as asthma, bronchospasm, or dys pnoea. In 33 of these cases the indication for treatment with angioten sin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patie nts within the first two weeks of treatment, and about one third neede d hospitalisation or drug treatment. Dyspnoea symptoms occurred in con junction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bro nchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relat ion to 11 different angiotensin converting enzyme inhibitors. Conclusi on-Symptoms of airway obstruction in relation to treatment with angiot ensin converting enzyme inhibitors seem to be a rare but potentially s erious reaction generally occurring within the first few weeks of trea tment.