Clinical Question: Is inhaled furosemide effective in improving dyspnea in patients with stable chronic obstructive pulmonary disease (COPD)?

Setting: Outpatient (specialty)

Study Design: Crossover trial (randomized)

Synopsis: This small crossover study included 20 patients older than 50 years with stable moderate to severe COPD (i.e., forced expiratory volume in less than one second of less than 70 percent of predicted) and with moderate to severe chronic breathlessness. Each patient inhaled furosemide (4 mL of furosemide as a 10 mg per mL solution) or placebo (4 mL of 0.9 percent saline solution), administered by means of a jet nebulizer. The treatment intervals were separated by at least two weeks and the initial drug was selected randomly. The patients underwent a standardized evaluation including exercise testing, symptom severity assessments, and spirometry.

The primary outcome was dyspnea as measured by a visual analog scale (VAS). One patient dropped out of the study because of acute symptoms after inhaling the placebo. The results were not impressive, although the authors (one of whom declared a conflict of interest) concluded otherwise. During the various evaluations, the VAS was not significantly different with the single exception of the constant workload stress test, in which the dyspnea VAS improved by 9 mm on a 100-mm scale. This difference, however, was not clinically important.

Bottom Line: Inhaled furosemide has no clinically important effect on breathlessness in patients with COPD. (Level of Evidence: 1b–)