75 Association of Supraglottic or Glottic Edema With Upper Aerodigestive Tract Edema

Abstract

Angioedema is a life-threatening diagnosis that results in more than one million emergency department (ED) visits per year and is a well-known adverse effect of angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitor-induced angioedema (AIAA) affects 0.1% to 0.7% of patients taking ACE inhibitors and accounts for approximately one-third of all ED visits for angioedema in the United States. Some studies have suggested that patients who have isolated lip or face edema are at low risk for airway interventions. However, other studies suggest that absence of upper aerodigestive tract edema may not reliably rule out laryngeal or glottic edema. The current literature is similarly conflicting with regard to the role of etiology in disease severity. We sought to determine the association between supraglottic or glottic edema with upper aerodigestive tract, lip and face edema in patients with AIAA. We performed a retrospective chart review of ED patients diagnosed with angioedema at Methodist LeBonheur Healthcare facilities in Memphis, TN from 1 January 2006 to 31 August 2016. Only patients greater than 18 years who underwent fiberoptic evaluation after diagnosis of AIAA were included in the final analysis. Among the 1,299 patients with angioedema, 954 were diagnosed with AIAA. Of these, 755 underwent fiberoptic evaluation. Mean age of patients with AIAA was 59 years, about 60% were female and 90% were African American. Four hundred thirty-four patients had lip swelling, 118 had soft palate swelling, 362 had anterior tongue swelling, 119 had floor of mouth swelling, 148 had base of tongue swelling and 89 had glottic or supraglottic swelling. Among patients who did not have lip swelling (321), 15% had glottic or supraglottic swelling evident on exam. Similarly, among patients who did not have anterior tongue swelling (393) or base of tongue swelling (607), 6% and 5.5% had supraglottic and/or glottic swelling, respectively. Supraglottic or glottic edema predicted need for intubation (OR 125; p=0.0001). In multivariate analysis, presence of soft palate swelling (OR 4; p=0.03) and base of tongue edema (OR 4.5; p=0.02) increased the likelihood of supraglottic or glottic edema on exam. However, there was no significant correlation between lip swelling (r= -0.09 ), soft palate swelling (r=0.3), anterior tongue swelling (r=0.18), floor of mouth swelling (r=0.32) or base of tongue swelling (r=0.39) with supraglottic or glottic swelling. This is a large study of patients with AAIA who underwent fiberoptic exams. Our study suggests that a significant portion of patients without upper aerodigestive tract swelling may still have supraglottic or glottic swelling. Since supraglottic and/or glottic swelling is considered a significant risk factor for predicting airway interventions, physicians should not use absence of upper aerodigestive tract swelling to reliably predict absence of supraglottic and/or glottic swelling.