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Tuesday, August 5, 2008

Furosimide nebs may decrease COPD dyspnea

One of the main reasons COPD patients seek medical attention, and why they are introduced to us RTs, is because they experience air hunger or dyspnea.

While there are a variety of steps we take in helping these patients overcome their dyspnea, one of which involves nebulized bronchodilators, there are new studies out that show that nebulized furosimide (Lasix) might work to help reduce dyspnea.

According to the Reuters Health Information, a report by Canadian researchers has revealed that "Inhalation of furosemide relieves exertional dyspnea in some patients with chronic obstructive pulmonary disease (COPD)."

Likewise, the article reports: "Exercise endurance time increased by an average of 21% (1.65 minutes) after treatment with furosemide compared with placebo, the authors report, and dyspnea intensity during exercise decreased by 0.9 Borg units with furosemide compared with placebo."

The writers of the report note that Lasix mainly worked for "patients with advanced COPD".

If this is accurate, then a 21% improvement to me seems pretty remarkable. A question I have is why? Why would Lasic work to improve dyspnea? had the best answer I could find:

"Recent evidence suggests that inhaled furosemide relieves dyspnoea in patients and in normal subjects made dyspnoeic by external resistive loads combined with added dead-space. Furosemide sensitizes lung inflation receptors in rats, and lung inflation reduces air hunger in humans. We therefore hypothesised that inhaled furosemide acts on the air hunger component of dyspnoea."
In doing further research on this, I found another study (click here) of 20 COPD patients that reveals the opposite, that Lasix has no effect on COPD patients.

Yet, here (click here) is yet another study that shows that Lasix does work, and here for yet another.

So, as one of the researchers of the report mentioned in the Reuters article listed above concludes, "This study therefore supports the rationale for future assessment of inhaled furosemide as a therapeutic intervention for patients with COPD with incapacitating dyspnea."

Still, I wonder what the significance of giving furosimide would be. And why is it that this drug is not researched further in the U.S., or are there plans to do so? Is this supposed to work better than current therapies for COPD patients, or just as another alternative like Xoponex is an alternative to Albuterol.

I also wonder what the significance would be for us RTs who give the treatments. Currently, when I do Mucomyst treatments, I stay out of the room as best I can. I'll watch the patient from a distance, but I don't want to be breathing that stuff in.

So, would us RTs need to be concerned about breathing in Lasix?

Having a bunch of RTs rushing to the bathroom every five minutes wouldn't be so bad, but what if we were to do Morphine or Ativan nebs? I can't imagine they'd be wanting us RTs in the room with the patient while these treatments were running.

These aerosol therapies are currently being studied too, and I have the results to some of them for a later post. It's interesting to wonder what we RTs might be up to in the years to come.


Anonymous said...

Lasix nebs...I can see it. I've givena fair number of morphine nebs in the past, and I can tell you from experience that the best way to do that is from across the room...or from right next to the patient. Depends on your perspective I guess!

As far as lasix nebs go, I wonder what effect they would have on CHFers? We might be able to give them a neb that helps them, unlike albuterol.

Rick Frea said...

That's another thing I was thinking and forgot to mention in my post. I was wondering if the COPD patients who benefited from this were actually just wet and the doctors failed to recognize it.

I know a lot of times we recognize a patient as being wet long before the doctor does.