Discontinuation of furosemide decreases PaCO(2) in patients with COPD.

Abstract

STUDY OBJECTIVE:

To evaluate whether the discontinuation of furosemide treatment resulted in a decrease in PaCO(2) and an increase in daytime and nocturnal oxygenation.

BACKGROUND:

Furosemide is widely prescribed in patients with COPD for the treatment of peripheral edema. It is known that furosemide causes a metabolic alkalosis. A diminished chemoreceptor stimulation may cause a decreased alveolar ventilation.

DESIGN:

Randomized, double-blind, placebo-controlled, crossover trial.

SETTING:

Department of Pulmonology, Rijnstate Hospital Arnhem, the Netherlands.

PATIENTS:

Twenty patients with stable COPD (10 men; median age, 70 years [range, 58 to 81 years]; FEV(1) 35% predicted [range, 19 to 70% predicted]). Subjects were included if they had received furosemide, 40 mg/d, for the treatment of peripheral edema for at least a month and if they had a mean nocturnal arterial oxygen saturation (SaO(2)) < 92%. Patients with cardiac left and/or right ventricular dysfunction, sleep apneas, and patients receiving other diuretics, angiotensin-converting enzyme inhibitors, potassium or chloride replacement therapy, or long-term oxygen treatment were excluded.

INTERVENTION:

Furosemide was discontinued for 1 week and replaced by placebo treatment in the first or the second week.

MEASUREMENTS AND RESULTS:

Ventilation, daytime arterial blood gas levels, and nocturnal SaO(2) were measured at baseline, after 1, and after 2 weeks. Sixteen subjects completed the study. Ventilation increased from 10.4 L/min (range, 6.7 to 15.4 L/min) at baseline to 11.6 L/min (range, 8.7 to 14.0 L/min) after discontinuation of furosemide (p < 0.05). PaCO(2) decreased from 45 mm Hg (range, 35 to 64 mm Hg) to 41 mm Hg (range, 32 to 61 mm Hg; p < 0.01). Daytime and nocturnal oxygenation did not improve.

CONCLUSIONS:

Although it does not improve oxygenation, the discontinuation of furosemide decreases PaCO(2) in patients with COPD.

• Authors: Folkert Brijker, Yvonne F Heijdra, Frank J J van den Elshout, Hans Th M Folgering
• Journal: Chest (Chest) Vol. 121 Issue 2 Pg. 377-82 (Feb 2002) ISSN: 0012-3692 [Print] United States
• PMID: 11834646 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Diuretics
• Furosemide
• Carbon Monoxide

Topics

• Aged
• Aged, 80 and over
• Body Fluids (metabolism)
• Carbon Monoxide (analysis)
• Cross-Over Studies
• Diuretics (pharmacology)
• Double-Blind Method
• Edema (drug therapy)
• Female
• Furosemide (pharmacology)
• Hemostasis (drug effects)
• Humans
• Male
• Middle Aged
• Oxygen Consumption (drug effects)
• Partial Pressure
• Pulmonary Disease, Chronic Obstructive (physiopathology)
• Respiratory Function Tests