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Discontinuation of Furosemide Decreases PaCO₂ in Patients With COPD^*

^* From the Department of Pulmonary Diseases (Drs. Brijker and van den Elshout), Rijnstate Hospital Arnhem; and Department of Pulmonology Dekkerswald (Drs. Heijdra and Folgering), University of Nijmegen, Nijmegen, the Netherlands.

Correspondence to: Folkert Brijker, MD, PhD, Department of Pulmonary Diseases, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, the Netherlands; e-mail: zonnebloem{at}compuserve.com

Study objective: To evaluate whether the discontinuation of furosemide treatment resulted in a decrease in PaCO₂ and an increase in daytime and nocturnal oxygenation.

Background: Furosemide is widely prescribed in patients with COPD for the treatment of peripheral edema. It is known that furosemide causes a metabolic alkalosis. A diminished chemoreceptor stimulation may cause a decreased alveolar ventilation.

Design: Randomized, double-blind, placebo-controlled, crossover trial.

Setting: Department of Pulmonology, Rijnstate Hospital Arnhem, the Netherlands.

Patients: Twenty patients with stable COPD (10 men; median age, 70 years [range, 58 to 81 years]; FEV₁ 35% predicted [range, 19 to 70% predicted]). Subjects were included if they had received furosemide, 40 mg/d, for the treatment of peripheral edema for at least a month and if they had a mean nocturnal arterial oxygen saturation (SaO₂) < 92%. Patients with cardiac left and/or right ventricular dysfunction, sleep apneas, and patients receiving other diuretics, angiotensin-converting enzyme inhibitors, potassium or chloride replacement therapy, or long-term oxygen treatment were excluded.

Intervention: Furosemide was discontinued for 1 week and replaced by placebo treatment in the first or the second week.

Measurements and results: Ventilation, daytime arterial blood gas levels, and nocturnal SaO₂ were measured at baseline, after 1, and after 2 weeks. Sixteen subjects completed the study. Ventilation increased from 10.4 L/min (range, 6.7 to 15.4 L/min) at baseline to 11.6 L/min (range, 8.7 to 14.0 L/min) after discontinuation of furosemide (p < 0.05). PaCO₂ decreased from 45 mm Hg (range, 35 to 64 mm Hg) to 41 mm Hg (range, 32 to 61 mm Hg; p < 0.01). Daytime and nocturnal oxygenation did not improve.

Conclusions: Although it does not improve oxygenation, the discontinuation of furosemide decreases PaCO₂ in patients with COPD.

Key Words: COPD • furosemide • hypercapnia • hypoventilation • metabolic alkalosis

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