Furosemide and Loop Diuretics in Human Asthma

Lockhart, A; Slutsky, Arthur S.

doi:10.1378/chest.106.1.244

Cited by 20 publications

(11 citation statements)

References 39 publications

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“…We observed no significant change in resting tests of airway function or plethysmographic lung volumes after treatment with inhaled furosemide compared with placebo. This finding is similar to previous studies in healthy subjects12 and in subjects with asthma 33. Interestingly, furosemide inhalation was associated with a significant increase in SVC by an average of 0.13 l. This may be explained, at least in part, by consistent increases in expiratory time during the VC manoeuvre (by an average of 1.7 s).…”

Section: Discussionsupporting

confidence: 91%

Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

Jensen

Amjadi

Harris-McAllister

et al. 2008

Thorax

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Background: This study examined the effects of inhaled furosemide on the ventilatory and perceptual response to high-intensity constant-load cycle exercise in chronic obstructive pulmonary disease (COPD). Methods: In a randomised, double-blind, placebocontrolled, crossover study, 20 patients with COPD (mean (SD) forced expiratory volume in 1 s 45 (15)% predicted) received either nebulised furosemide 40 mg or placebo on two separate days. Thirty minutes after each treatment, patients performed pulmonary function tests and a symptom-limited cycle exercise test at 75% of their maximum incremental work rate. Changes in spirometry, plethysmographic lung volumes, dynamic operating lung volumes, ventilation, breathing pattern, cardiovascular function, dyspnoea intensity and exercise endurance time were compared between treatments. Results: Compared with placebo, treatment with furosemide resulted in a mean (SD) decrease in dyspnoea intensity at the highest equivalent exercise time (ie, isotime for each patient) of 0.9 (1.0) Borg units (p,0.01) and an increase in exercise endurance time of 1.65 (0.63) min (p,0.05). These improvements were associated with increases in dynamic inspiratory capacity, tidal volume and mean tidal expiratory flow rates at isotime (p,0.01). The eight patients whose exercise endurance time improved by .1 min had greater changes in operating lung volumes (p,0.05), submaximal oxygen pulse (p,0.05) and oxygen uptake (p = 0.05) than those in whom exercise endurance time did not improve. Conclusion: Alleviation of exertional dyspnoea after single-dose furosemide inhalation in COPD is multifactorial but improvements in dynamic ventilatory mechanics are contributory in some individuals.Perceived respiratory difficulty (dyspnoea) and activity limitation are the dominant symptoms of chronic obstructive pulmonary disease (COPD) and contribute importantly to perceived poor health-related quality of life in this population.

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Section: Discussionsupporting

confidence: 91%

Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

Jensen

Amjadi

Harris-McAllister

et al. 2008

Thorax

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“…As no significant protective effect is ob served against histamine-or methacholine-induced bronchoconstriction by inhaled frusemide, it does not appear to exert a direct effect on airway smooth muscle [6,8]. In vitro studies suggest that it may, in part, be due to inhibi tion of the release of inflammatory mediators [9]. How ever, our present series and a previous study [4] on acute asthma have demonstrated that inhaled frusemide re lieved bronchial obstruction within 30 min.…”

Section: Discussionsupporting

confidence: 42%

Rapid Response to Inhaled Frusemide in Severe Acute Asthma with Hypercapnia

Tanigaki

Kondo²,

Hayashi³

et al. 1997

Respiration

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We report 7 patients with severe acute asthma unresponsive to standard medication, including sympathomimetic agents, aminophylline and corticosteroids, who responded to inhaled frusemide. All were hypercapneic with a mean PaC02 of 7.7 kPa (57.7 mm Hg) [range 6.2-8.8 kPa (46.2-66.3 mm Hg)]. Following nebulization of 20 mg frusemide, clinical response was rapid, and the mean PaCO₂ fell significantly to 5.4 kPa (40.6 mm Hg) [range 5.0-6.2 kPa (37.5-46.5 mm Hg)] within 20-60 min. No adverse effect was recognized. Inhaled frusemide should be considered for treatment of acute asthma refractory to conventional therapy.

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“…Furosemide has been shown to have a bronchodilator effect similar to that of salbutamol 14. It has been proposed that the airways of patients with asthma adapt poorly to local osmotic changes, which is related to lack of control of the osmolality and ionic concentration of the fluid covering the airway due to a defect on the bronchial epithelium.…”

Section: Discussionmentioning

confidence: 99%

New complexes of inhaled furosemide and cyclodextrin: assessment of the bronchodilator effect

Al-Shdefat

2015

Eur J Hosp Pharm

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ObjectivesThe objective of this study was to investigate the efficacy in children of nebulised furosemide administered singly or in combination with β-cyclodextrins (β-CDs) on asthma exacerbations.MethodsA single-blinded randomised controlled study was conducted in five groups of children with moderate asthma. Twenty children were enrolled in each group: group 1 received nebulised salbutamol, group 2 received nebulised furosemide, group 3 received both salbutamol and furosemide, group 4 received a mixture of furosemide and β-CD in a 1:0.5 molar ratio, and group 5 received a mixture of furosemide and β-CD in a 1:1 molar ratio. Pulmonary function parameters, peak flow rates, respiratory rate, oxygen saturation and clinical scores were obtained before and after treatment.ResultsThe primary outcome of forced expiratory volume in 1 s (FEVl) improved after drug administration in all five groups of patients. The greatest FEVl% improvement was seen in group 3 children treated with the combination of furosemide and salbutamol (22.0±1.9; p<0.001). The greatest increases in forced vital capacity (FVC) were seen in group 3 (21.6±1.6; p<0.001) and group 4 (20.9±1.8; p<0.001).ConclusionsComplexes of furosemide and CDs led to a significant increase in peak flow rate and significantly improved FEV1, FVC, respiratory rate, arterial oxygen saturation (SaO2) and clinical scores as compared to other treatments. The complex effect was nearly equal to that of the furosemide and salbutamol combination. These results suggest that CDs are a promising approach for improving the efficacy of poorly water-soluble drugs administered by inhalation.

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Furosemide and Loop Diuretics in Human Asthma

Cited by 20 publications

References 39 publications

Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

Rapid Response to Inhaled Frusemide in Severe Acute Asthma with Hypercapnia

New complexes of inhaled furosemide and cyclodextrin: assessment of the bronchodilator effect

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