Nebulized furosemide relieves dyspnea in patients with terminal cancer

NEW YORK (Reuters Health) – Inhalation of nebulized furosemide can relieve severe dyspnea for weeks in patients with terminal cancer, Japanese physicians report.

Dr. Naohito Shimoyama, of the National Cancer Center Hospital in Tokyo, and Dr. Megumi Shimoyama, of the Chiba University School of Medicine, describe three patients who were experiencing dyspnea scored from 7 to 10 on a 10-point visual analog scale. Causes of dyspnea were pulmonary metastases, cancer recurrence under the bifurcation of the trachea, and pleural effusion.

Rescue doses of morphine, oxygen therapy, nebulizer treatment with orciprenaline, and in the latter case, chest drainage, all failed to provide relief, according to the investigators' report in the January issue of the Journal of Pain and Symptom Management.

Treatment was initiated in all three cases with 20 mg nebulized furosemide administered four times a day. Relief was noted within 30 minutes, with visual analog scores decreasing to no more than 3/10. In two cases, respiratory rate decreased significantly. In each case, dyspnea was well controlled for the 2 to 3 weeks remaining until the patients died.

Drs. Shimoyama and Shimoyama note that furosemide's effects were local, enhancing pulmonary stretch receptor activities and suppressing pulmonary irritant receptor activities. No side effects, including diuresis, were observed. The authors recommend future controlled trials to evaluate the effectiveness of inhaled nebulized furosemide in terminal cancer patients.

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