{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:09:17Z","timestamp":1753870157355,"version":"3.41.2"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,9,20]],"date-time":"2023-09-20T00:00:00Z","timestamp":1695168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cough\u2010 and asthma\u2010like symptoms are common adverse reactions to angiotensin\u2010converting enzyme inhibitors (ACEi). However, attributing these symptoms to the use of ACEi might be masked by clinical confounders. We report a 68\u2010year\u2010old female residing in a long\u2010term acute\u2010care facility for patients requiring prolonged invasive mechanical ventilation treated for years with ACEi. Daily reversible bouts of life\u2010threatening severe bronchospasm gradually developed over 6\u2009weeks and abruptly resolved following the cessation of ACEi treatment. The late appearance of bronchospasm and the unique clinical setup of chronic invasive ventilation in a patient with smoking\u2010related chronic obstructive lung disease are among the principal confounders that delay the identification of the causative association between ACEi and respiratory compromise. Chronic positive pressure ventilation may also conceal small airway reactivity and obstruction, similar to auto\u2010positive end\u2010expiratory pressure (auto\u2010PEEP). Conceivably, angiotensin receptor blockers should be preferred over ACEi in such patients.<\/jats:p>","DOI":"10.1002\/rcr2.1224","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T06:20:20Z","timestamp":1695277220000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Life\u2010threatening bronchospasm induced by an angiotensin\u2010converting enzyme inhibitor in a chronically ventilated patient: Diagnostic pitfalls and literature review"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-825X","authenticated-orcid":false,"given":"Esther\u2010Lee","family":"Marcus","sequence":"first","affiliation":[{"name":"Long\u2010Term Respiratory Care Division, Herzog Medical Center; Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Hush","sequence":"additional","affiliation":[{"name":"Long\u2010Term Respiratory Care Division, Herzog Medical Center; Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisham","family":"Atrash","sequence":"additional","affiliation":[{"name":"Long\u2010Term Respiratory Care Division, Herzog Medical Center; Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roaia","family":"Shibli","sequence":"additional","affiliation":[{"name":"Long\u2010Term Respiratory Care Division, Herzog Medical Center; Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel N.","family":"Heyman","sequence":"additional","affiliation":[{"name":"Department of Medicine Hadassah\u2010Hebrew University Hospital, Mt. 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