EFFECT OF INHALED FUROSEMIDE IN ACUTE ASTHMA

We assessed the acute bronchodilator effect of nebulized furosemide wh en added to conventional therapy of acute emergency department (ED) as thma. Using a double-blind design, 42 patients with acute asthma were randomized to receive 2.5 mg nebulized salbutamol and either 40 mg of nebulized furosemide or saline solution. We recorded clinical variable s (respiratory rate, heart rate, and pulsus paradoxus) and peak expira tory flow rates (PEFR) before and 15 and 30 min after therapy. We foun d no significant difference in PEFR between salbutamol/furosemide and salbutamol/saline-treated patients 15 and 30 min following inhalation. Other endpoints were equally unaffected. However, when we examined se parately those patients whose exacerbations were of relative short dur ation (<8 hr), PEFR improved significantly more in the furosemide-trea ted group. At 15 min, PEFR increased by 82 +/- 48% in the furosemide g roup compared to 35 +/- 40% in the control group (p = 0.03), an effect that was also evident at 30 min when PEFR had increased by 113 +/- 49 % in the furosemide group versus 61 +/- 35% in the control group (p = 0.014). Respiratory rate, heart rate, and pulsus paradoxus improved wi th no differences between the groups. The beneficial effect of furosem ide was not evident in patients who reported more prolonged duration ( >8 hr) of asthmatic symptoms, The response to furosemide appeared to b e unrelated to concomitant ED therapy with corticosteroids, to baselin e pulmonary function, or to patient demographic variables. We conclude that furosemide may offer additive bronchodilator benefits in acute n aturally occurring asthma of relative short duration.