Newton, P.J., Davidson, P.M., Macdonald, P., Ollerton, R., & Krum H. (2008). Nebulized furosemide for the management of dyspnea: Does the evidence support its use? Journal of Pain & Symptom Management, 36(4), 424-441.

The objective of the study is to synthesize information regarding the effect of nebulized furosemide in managing dyspnea.

• Databases searched were MEDLINE, EMBASE, CINAHL, and the Internet (1988–2006), and a manual search of article references was done.
• Search keywords were dyspnea, breathlessness, inhaled, nebulized, and furosemide.
• Studies were included if they reported on findings of experimental or clinical trial of nebulized furosemide for management of dyspnea in adults.
• No exclusion criteria were specified.

• The initial search provided 112 citations. 
• The report states that a critical review of evidence was done. 
• No specific process or review/quality criteria are described.

The final sample included 42 articles, including 39 randomized controlled trials; 2 studies in cancer, 35 in asthma, 8 studies in health volunteers, and 1 in chronic obstructive pulmonary disease.

• Some evidence suggests that nebulized furosemide could be an option in the management of dyspnea, but sufficiently powered experimental studies are lacking to have a strong conclusion in this area.
• Data in reports regarding possible diuretic effects of nebulized furosemide are lacking.
   

• Strong evidence is lacking to draw conclusions regarding effectiveness of nebulized furosemide for dyspnea management, and reporting of any diurectic effects of this approach also is lacking.
• Research in this area has a number of methodologic limitations that preclude drawing any firm conclusions.
• As some evidence exists of symptom relief produced by nebulized furosemide, further evaluation may be warranted, with appropriate placebo-controlled research.

Dyspnea was only measured in five studies reviewed.

This review demonstrates a lack of strong evidence in the area of nebulized furosemide for dyspnea and little evidence was found in the management of dyspnea in patients with cancer.