The Acute Haemodynamic Effect of Nebulised Frusemide in Stable, Advanced Heart Failure

Newton, Phillip J.; Davidson, Patricia M.; Krum, Henry; Ollerton, Richard L.; Macdonald, P.

doi:10.1016/j.hlc.2012.03.002

Cited by 12 publications

(4 citation statements)

References 27 publications

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“…Further support for a mechanism of relief of AH via direct actions in the lungs is provided by: i) direct exposure of the lung tissue to furosemide in rat preparations resulted in modulation of PSR afferent activity but not when administered intravenously [ 6 ] ii) other studies in which beneficial effects of furosemide have been evident only when inhaled rather than administered via tablet [ 35 ] iii) absence of haemodynamic changes with inhaled furosemide in a study assessing wedge pressure measurements in heart failure patients suggesting no systemic mechanism of action [ 48 ] iv) absence of any detectable difference in cumulative urine output between the two groups in this study (SFS and FSF) which discounts a mechanism of action related to diuresis.…”

Section: Discussionmentioning

confidence: 99%

Inhaled furosemide for relief of air hunger versus sense of breathing effort: a randomized controlled trial

et al. 2018

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BackgroundInhaled furosemide offers a potentially novel treatment for dyspnoea, which may reflect modulation of pulmonary stretch receptor feedback to the brain. Specificity of relief is unclear because different neural pathways may account for different components of clinical dyspnoea. Our objective was to evaluate if inhaled furosemide relieves the air hunger component (uncomfortable urge to breathe) but not the sense of breathing work/effort of dyspnoea.MethodsA randomised, double blind, placebo-controlled crossover trial in 16 healthy volunteers studied in a university research laboratory. Each participant received 3 mist inhalations (either 40 mg furosemide or 4 ml saline) separated by 30–60 min on 2 test days. Each participant was randomised to mist order ‘furosemide-saline-furosemide’ (n- = 8) or ‘saline-furosemide-saline’ (n = 8) on both days. One day involved hypercapnic air hunger tests (mean ± SD PCO2 = 50 ± 3.7 mmHg; constrained ventilation = 9 ± 1.5 L/min), the other involved work/effort tests with targeted ventilation (17 ± 3.1 L/min) and external resistive load (20cmH2O/L/s). Primary outcome was ratings of air hunger or work/effort every 15 s on a visual analogue scale. During saline inhalations, 1.5 mg furosemide was infused intravenously to match the expected systemic absorption from the lungs when furosemide is inhaled. Corresponding infusions of saline during furosemide inhalations maintained procedural blinding. Average visual analogue scale ratings (%full scale) during the last minute of air hunger or work/effort stimuli were analysed using Linear Mixed Methods.ResultsData from all 16 participants were analysed. Inhaled furosemide relative to inhaled saline significantly improved visual analogues scale ratings of air hunger (Least Squares Mean ± SE − 9.7 ± 2%; p = 0.0015) but not work/effort (+ 1.6 ± 2%; p = 0.903). There were no significant adverse events.ConclusionsInhaled furosemide was effective at relieving laboratory induced air hunger but not work/effort in healthy adults; this is consistent with the notion that modulation of pulmonary stretch receptor feedback by inhaled furosemide leads to dyspnoea relief that is specific to air hunger, the most unpleasant quality of dyspnoea.FundingOxford Brookes University Central Research Fund.Trial registrationClinicalTrials.gov Identifier: NCT02881866. Retrospectively registered on 29th August 2018.

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Section: Discussionmentioning

confidence: 99%

Inhaled furosemide for relief of air hunger versus sense of breathing effort: a randomized controlled trial

et al. 2018

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“…The 2 h post-intervention urine output in the three arms in the RCT by Wilcock et al 29 were not significantly different, indicating that nebulised furosemide did not have a diuretic effect. A recent RCT by Newton et al 38 which studied the acute haemodynamic effects of nebulised furosemide in stable, advanced heart failure showed a significant increase in diuresis (volume of urine on bladder scan) in patients who received nebulised furosemide 40 mg as compared to placebo. However, there is no clear evidence that diuresis is a possible mechanism of action for nebulised furosemide when used in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Nebulised furosemide in the palliation of dyspnoea in cancer: a systematic review

Jeba

George

Pease

2013

BMJ Support Palliat Care

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“…Animal models suggest a potential role for furosemide in changing local chloride ion channels and its negative effect on c-fibers receptor and vagal irritant receptors, and an associated positive effect on alveolar stretch receptors. 50 Nebulised inhaled furosemide (NIF) has been tested in acute breathlessness induced in healthy volunteers and in people with acute asthma 51 , COPD 52 53 54 , heart failure 55 and lung cancer. [56][57][58][59]…”

Section: Nebulized Furosemidementioning

confidence: 99%

Non-opioid medications for the relief of chronic breathlessness: current evidence

Barbetta

Currow

Johnson

2017

Expert Review of Respiratory Medicine

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To evaluate systematically randomised clinical trials investigating non-opioid medications for the management and treatment of chronic breathlessness. Areas covered: The evidence for the role of benzodiazepines, anxiolytics, selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, cannabinoids, nebulized furosemide and herbal-based treatments were critically reviewed. Search of the Clinical Trials Registry (Clinicaltrial.gov) identified ongoing studies expected to generate new data in the near future in several classes of non-opioid medications for their net effect on chronic breathlessness. Expert commentary: Morphine still has the best level of evidence for the symptomatic treatment of chronic breathlessness. Non-opioid treatments for chronic breathlessness are less studied than morphine and morphine-related medications although evidence is emerging in relation to some options. Currently, there is insufficient evidence to recommend non-opioids in the routine treatment of chronic breathlessness. There is a need to find agents, new as well as re-purposed, that can be used as alternative therapies to opioids for chronic breathlessness for people who are unable to tolerate morphine.

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The Acute Haemodynamic Effect of Nebulised Frusemide in Stable, Advanced Heart Failure

Cited by 12 publications

References 27 publications

Inhaled furosemide for relief of air hunger versus sense of breathing effort: a randomized controlled trial

Inhaled furosemide for relief of air hunger versus sense of breathing effort: a randomized controlled trial

Nebulised furosemide in the palliation of dyspnoea in cancer: a systematic review

Non-opioid medications for the relief of chronic breathlessness: current evidence

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