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Controlled Delivery of 80 mg Aerosol Furosemide Does Not Achieve Consistent Dyspnea Relief in Patients

  • COPD
  • Published:
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Abstract

Purpose

Aerosol furosemide may be an option to treat refractory dyspnea, though doses, methods of delivery, and outcomes have been variable. We hypothesized that controlled delivery of high dose aerosol furosemide would reduce variability of dyspnea relief in patients with underlying pulmonary disease.

Methods

Seventeen patients with chronic exertional dyspnea were recruited. Patients rated recently recalled breathing discomfort on a numerical rating scale (NRS) and the multidimensional dyspnea profile (MDP). They then performed graded exercise using an arm-ergometer. The NRS was completed following each exercise grade, and the MDP was repeated after a pre-defined dyspnea threshold was reached. During separate visits, patients received either aerosol saline or 80 mg of aerosol furosemide in a randomized, double-blind, crossover design. After treatment, graded exercise to the pre-treatment level was repeated, followed by completion of the NRS and MDP. Treatment effect was defined as the difference between pre- and post-treatment NRS at end exercise, expressed in absolute terms as % Full Scale. “Responders” were defined as those showing treatment effect ≥ 20% of full scale.

Results

Final analysis included 15 patients. Neither treatment produced a statistically significant change in NRS and there was no significant difference between treatments (p = 0.45). There were four “responders” and one patient whose dyspnea worsened with furosemide; two patients were responders with saline, of whom one also responded to furosemide. No adverse events were reported.

Conclusions

High dose controlled delivery aerosol furosemide was not statistically different from saline placebo at reducing exercise-induced dyspnea. However, a clinically meaningful improvement was noted in some patients.

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Acknowledgements

The authors would like to thank the participants who made this study possible, as well as the staff of the Clinical Research Center at the Beth Israel Deaconess Medical Center. Special thanks to Joe Brain and Jim Butler for their advice on aerosol delivery, and to Robert Lansing for his critical input on experimental design and manuscript preparation.

Funding

Supported by NIH grant NR12009.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Robert W. Hallowell, Richard Schwartzstein, Carl R. O’Donnell, Andrew Sheridan & Robert B. Banzett

  2. Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA

    Richard Schwartzstein, Carl R. O’Donnell & Robert B. Banzett

Authors
  1. Robert W. Hallowell
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  2. Richard Schwartzstein
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  3. Carl R. O’Donnell
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  4. Andrew Sheridan
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  5. Robert B. Banzett
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Correspondence to Robert B. Banzett.

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Hallowell, R.W., Schwartzstein, R., O’Donnell, C.R. et al. Controlled Delivery of 80 mg Aerosol Furosemide Does Not Achieve Consistent Dyspnea Relief in Patients. Lung 198, 113–120 (2020). https://doi.org/10.1007/s00408-019-00292-7

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  • DOI: https://doi.org/10.1007/s00408-019-00292-7

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