Kohara, H., Ueoka, H., Aoe, K., Maeda, T., Takeyama, H., Saito, R., . . . Uchitomi, Y. (2003). Effect of nebulized furosemide in terminally ill cancer patients with dyspnea. Journal of Pain and Symptom Management, 26(4), 962–967.doi: 10.1016/S0885-3924(03)00322-1
The objective of the study is to assess the effect of nebulized furosemide (20 mg) on dyspnea uncontrolled by standard therapy in patients with terminal cancer.
Patients inhaled 20 mg of furosemide diluted with 3 ml of normal saline through an ultrasonic nebulizer over 10 minutes.
The study reported on a sample of 15 patients in a palliative care unit with histologic diagnosis of malignant disease and the presence of dyspnea that resists standard treatments.
Uncontrolled, open study
Initial severity of dyspnea was grade 4, assessed with the Hugh-Jones 0–4 classification. Effects were evaluated using the Cancer Dyspnea Scale before treatment and 60 minutes following treatment. Hemoglobin oxygen saturation and heart rate (HR) were measured with a pulse oximeter. Respiratory rate (RR), HR, and arterial blood gas parameters also were determined before and 60 minutes after use of nebulized furosemide. In addition, patients were asked whether they felt relief with the treatment and whether they hoped to continue the treatment.
The study showed that the inhalation of nebulized furosemide alleviated the sensation of dyspnea according to decreased Cancer Dyspnea Scale scores for sense of effort, sense of anxiety, and total dyspnea. However, objective data such as arterial oxygenation (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygen saturation, HR, and RR did not change with treatment.
The study had several limitations. It was an uncontrolled, open study and, thus, the results may include a placebo effect from the intervention itself. The assessment of dyspnea was conducted on only two occasions—before and after administration of a single dose. Finally, the sample size was small.