Discontinuation of Furosemide Decreases Paco2 in Patients With COPD

Brijker, Folkert; Heijdra, Yvonne F.; Elshout, Frank J.J. van den; Folgering, H.T.M.

doi:10.1378/chest.121.2.377

Cited by 33 publications

(16 citation statements)

References 30 publications

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“…Consistent with its expected pharmacodynamic characteristics, systemic furosemide is capable of inducing a metabolic alkalosis by increasing urinary hydrogen (H ϩ ) loss. 25 Although the effect of nebulized furosemide on dyspnea is likely to be independent of its systemic diuretic effect, 18,26 the systemic effect of nebulized furosemide has not been ruled out. 17 Both heart rate and blood pressure decreased in the furosemide group, by about 4 beats/min and 9 mm Hg, respectively, which is consistent with the results in the study by Rodriguez Vazquez et al 13 ; however, these changes were not clinically important.…”

Section: Discussionmentioning

confidence: 99%

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

Vahedi

Mahshidfar

Rabiee³

et al. 2013

Respir Care

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OBJECTIVE:To examine the effect of nebulized furosemide as an adjunct to the conventional treatment of patients with COPD exacerbation in an emergency department. METHODS: In this randomized double-blinded clinical trial, patients with COPD exacerbation were randomized to receive 40 mg nebulized furosemide or placebo as an adjunct to the conventional treatments. We recorded changes in dyspnea severity (measured with a visual analog scale), FEV 1 , arterial blood gas measurements, blood pressure, heart rate, and breathing frequency at baseline and 1 hour after treatment. RESULTS: We randomized 100 patients, whose mean age was 73.1 ؎ 8.7 y. The measured variables all improved significantly in both groups. FEV 1 , dyspnea, pH, mean blood pressure, and heart rate improved significantly more in the furosemide group. CONCLUSIONS: Nebulized furosemide benefits patients with COPD exacerbation.

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Section: Discussionmentioning

confidence: 99%

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

Vahedi

Mahshidfar

Rabiee³

et al. 2013

Respir Care

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“…If no hypercapnia is present, then the alkalosis may result in diminished chemoreceptor stimulation, and hence decreased alveolar ventilation. This hypothesis was tested in 16 COPD patients: when furosemide treatment was discontinued for 1 week, VE increased by 10% and arterial PCO 2 decreased from the range of 45 to 41 mmHg, although there was no improvement of daytime and nocturnal oxygenation (28).…”

Section: Chronic Obstructive Pulmonary Disease (Copd)mentioning

confidence: 99%

Effects of Gas Exchange on Acid‐Base Balance

Lindinger

Heigenhauser

2012

Comprehensive Physiology

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This paper describes the interactions between ventilation and acid-base balance under a variety of conditions including rest, exercise, altitude, pregnancy, and various muscle, respiratory, cardiac, and renal pathologies. We introduce the physicochemical approach to assessing acid-base status and demonstrate how this approach can be used to quantify the origins of acid-base disorders using examples from the literature. The relationships between chemoreceptor and metaboreceptor control of ventilation and acid-base balance summarized here for adults, youth, and in various pathological conditions. There is a dynamic interplay between disturbances in acid-base balance, that is, exercise, that affect ventilation as well as imposed or pathological disturbances of ventilation that affect acid-base balance. Interactions between ventilation and acid-base balance are highlighted for moderate- to high-intensity exercise, altitude, induced acidosis and alkalosis, pregnancy, obesity, and some pathological conditions. In many situations, complete acid-base data are lacking, indicating a need for further research aimed at elucidating mechanistic bases for relationships between alterations in acid-base state and the ventilatory responses.

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“…Some suggest postponing diuretics as long as possible [252,260]. Diuretics can aggravate retention of sodium and water [252,260] through several pathways including hypoventilation-induced hypocloraemic metabolic alkalosis [280,281]. Others suggest the use of angiotensin-converting enzyme inhibitors to increase sodium excretion [256].…”

Section: Review: Endocrinological Derangements In Copd F Laghi Et Almentioning

confidence: 99%

Endocrinological derangements in COPD

Laghi

Adıgüzel²,

Tobin³

2009

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders, such as those involving the pituitary, the thyroid, the gonads, the adrenals and the pancreas.The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxaemia, hypercapnia, systemic inflammation and glucocorticoid administration. Altered endocrine function can worsen the clinical manifestations of COPD through several mechanisms, including decreased protein anabolism, increased protein catabolism, nonenzymatic glycosylation and activation of the rennin-angiotensin-aldosterone system.Systemic effects of endocrine disorders include abnormalities in control of breathing, decreases in respiratory and limb-muscle mass and function, worsening of respiratory mechanics, impairment of cardiac function and disorders of fluid balance.Research on endocrine manifestations of COPD embraces techniques of molecular biology, integrative physiology and controlled clinical trials. A sound understanding of the various disorders of endocrine function associated with COPD is prudent for every physician who practices pulmonary medicine.

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Discontinuation of Furosemide Decreases Paco2 in Patients With COPD

Cited by 33 publications

References 30 publications

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

Effects of Gas Exchange on Acid‐Base Balance

Endocrinological derangements in COPD

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