Chest
Clinical InvestigationsCOPDDiscontinuation of Furosemide Decreases Paco2 in Patients With COPD
Section snippets
Subjects
The study was performed in 20 patients with COPD (10 men; median age, 70 years [range, 58 to 81 years]; median FEV1, 35% predicted [range, 19 to 70% predicted]).19 Subjects were included if they had a stable course of the disease. COPD was defined according to the standards of the American Thoracic Society,20 and a disease stability was defined as a fluctuation of FEV1 of < 10% over the last 6 months and an absence of exacerbations for at least 8 weeks prior to the study. Moreover, subjects
Results
Sixteen subjects completed the study. Urine analysis showed a full compliance with respect to the study medication. Of the four subjects who did not complete the study, one patient had a weight gain of 3.5 kg after 4 days without furosemide, associated with an increase in peripheral edema and worsening of dyspnea; two patients were not willing to continue the study; and one patient became unstable during the study: terminal respiratory failure (FEV1, 29% predicted; Paco2, 62 mm Hg) aggravated
Discussion
The discontinuation of furosemide, prescribed for peripheral edema in patients with stable COPD with a mean nocturnal Sao2 < 92%, resulted in an increased minute ventilation and a decrease in Paco2. This was not associated with an increase in daytime or nocturnal oxygenation.
The increased BE, accompanied by a normal pH, confirms a respiratory-compensated metabolic alkalosis at baseline. The correction of the alkalosis, due to the withdrawal of furosemide, resulted in decreased BE and
References (32)
- et al.
Compensatory hypoventilation in metabolic alkalosis
Chest
(1982) Furosemide decreases ventilation in young rabbits
J Pediatr
(1985)Life expectancy in severe COPD
Chest
(1994)- et al.
Reversible hypercapnia in chronic obstructive pulmonary disease: a distinct pattern of respiratory failure with a favorable prognosis
Am J Med
(1997) - et al.
Relative survival analysis of 252 patients with COPD receiving long-term oxygen therapy
Chest
(1998) - et al.
Pathogenesis of congestive state in chronic obstructive pulmonary disease: studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery
Circulation
(1992) Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part two
Am J Respir Crit Care Med
(1994)Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part one
Am J Respir Crit Care Med
(1994)Diuretics
Kidney Int
(1991)- et al.
Inhibition of aortic chemoreceptor responses by metabolic alkalosis in the cat
J Appl Physiol
(1982)
Relative peripheral and central chemosensory responses to metabolic alkalosis
Am J Physiol
Metabolic alkalosis and hypoventilation in humans
Am Rev Respir Dis
Effect of metabolic alkalosis on respiratory function in patients with chronic obstructive lung disease
Can Med Assoc J
Breathing during sleep in patients with nocturnal desaturation
Am J Respir Crit Care Med
Nonapneic mechanisms of arterial oxygen desaturation during rapid-eye-movement sleep
J Appl Physiol
Evolution of nocturnal oxyhemoglobin desaturation in patients with chronic obstructive pulmonary disease and a daytime Pa o2 above 60 mm Hg
Am Rev Respir Dis
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The study was supported by Glaxo Wellcome, Zeist, the Netherlands.