Randomised, Placebo-Controlled Trial Of Nebulised Furosemide For Breathlessness In Patients With Cancer
Andrew Wilcock 1*, Abi Walton 2, Cathann Manderson 2, Luke Feathers 2, Bisharat El Khoury 2, Mary Lewis 2, Alpna Chauhan 2, Paul Howard 2, Sarah Bell 2, Jacky Frisby 2 and Anne Tattersfield 1
1 Nottingham University, United Kingdom
2 Nottingham University Hospitals NHS Trust, United Kingdom
* To whom correspondence should be addressed. E-mail: andrew.wilcock{at}nottingham.ac.uk.
Accepted 21 March 2008
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Background: Breathlessness is a common and difficult symptom to treat in patients with cancer. Case reports suggest that nebulised furosemide can relieve breathlessness in such patients but few data are available.
Method: Patients with primary or secondary lung cancer and a Dyspnoea Exertion Scale score of >=3 were recruited. Following familiarisation patients received either nebulised furosemide 40mg or nebulised 0.9% saline under double-blind conditions or no treatment, in random order on three consecutive days. Patients undertook number reading and arm exercise tests to assess breathlessness and its impact, and were asked to report subjective benefit and any preference between nebulised treatments.
Results: Fifteen patients took part. There were no differences between furosemide, saline and no treatment in the outcomes of the number reading test (e.g. mean number read per breath was 6.7, 6.4 and 6.7 respectively) or arm exercise test (e.g. mean Borg score at maximum equivalent workload was 2.3, 2.5 and 2.7 respectively). No adverse effects were reported, although there was a small fall in FEV1 and FVC following saline. Six patients considered that their breathlessness improved with nebulised treatment, three preferring saline, one furosemide and two reporting they were of equal benefit.
Conclusions: Our findings do not support a beneficial effect from nebulised furosemide in patients with cancer-related breathlessness.
