Therapeutic use of progesterone in alveolar hypoventilation associated with obesity

doi:10.1016/0002-9343(68)90088-0

The American Journal of Medicine

Volume 44, Issue 6, June 1968, Pages 881-888

https://doi.org/10.1016/0002-9343(68)90088-0 Get rights and content

Abstract

A study was made of eight very obese patients, average body weight 325 pounds, with the alveolar hypoventilation syndrome. Initial treatment included a low calorie intake, the administration of digitalis and diuretics, and intermittent positive pressure breathing. After a stable level of improvement was reached, within five to twenty-three days, 100 mg. of progesterone was given daily by intramuscular injection. Progesterone therapy increased alveolar ventilation by an additional 29.3 per cent and total minute ventilation by 20.6 per cent. Arterial blood gas tensions and pH were returned toward normal and respiratory acidosis was abolished. Abnormal ventilatory-carbon dioxide response curves were restored to normal by progesterone therapy. Progesterone is thus an effective agent for improving ventilation in patients with the obesity-hypoventilation syndrome. The site and mode of action of progesterone is unknown. Respiratory control was normal during progesterone administration, but reappearance of an abnormal state recurred within a month after progesterone therapy was discontinued.

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Beyond noninvasive ventilation, the treatment options for patients with obesity hypoventilation syndrome (OHS) are very limited. Weight loss probably cures OHS. But the extent of weight loss needed for cure is severe and can only be reliably achieved with bariatric surgery. Our understanding of the role of surgery and its safety in patients with OHS remains limited. Tracheostomy is also effective in improving ventilation, but it is rarely performed. Ventilation can be increased or decreased with medication. This chapter summarizes our current knowledge of these interventions.
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Daytime hypercapnia that develops in morbidly obese individuals in the absence of concurrent lung or neuromuscular disease is referred to as the obesity hypoventilation syndrome (OHS). The characteristic polysomnographic (PSG) abnormality is marked sleep hypoxemia. Although the likelihood of hypoventilation increases with increasing body mass index (BMI), it is too simplistic to think of this disorder arising merely from chest wall restriction due to excess weight. Rather, this is a disorder which emerges when the compensatory mechanisms that normally operate to maintain ventilation appropriate for the level of obesity are impaired. OHS develops from a complex interaction between abnormal respiratory function, sleep disordered breathing and diminished respiratory drive. Irrespective of the mechanisms underlying the development of this disorder, early recognition of the problem and institution of effective therapy is important to reduce the significant clinical and societal repercussions of OHS. While therapy directed at improving sleep disordered breathing is effective in reversing daytime respiratory failure, it is not universally successful and information regarding longer term clinical outcomes is limited. Attention to weight reduction strategies are also necessary to reduce comorbid conditions and improve quality of life, but data regarding how successful and sustained this is in obesity hypoventilation are sparse.
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^☆: This study was supported by the U.S. Public Health Service Grant No. 5T1 HE 5485-05 and NB 01594.

¹: From the Department of Medicine, State University of New York, Downstate Medical Center and the Medical Service of the Kings County Hospital Center, Brooklyn, New York.

^†: Work performed during tenure as Trainee of U.S. Public Health Service under Grant 5T1 HE 5485-05.

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Clinical studyTherapeutic use of progesterone in alveolar hypoventilation associated with obesity☆

Abstract

Fertil. & Steril.

Am. J. Med.

J. Biol. Chem.

Am. J. Med.

Am. J. Med.

Ein Beitrag zur Respirationphysiologie der Graviditaet

Skandinav. Arch. Physiol.

Ueber die Kohlensäurespannung des Blutes in der Graviditaet

Ztschr. klin. Med.

Die Neutralitaetregulation des graviden Organismus

Biochem. Ztschr.

Atmung und Saeure-Basengleichgewicht in der Schwangerschaft

Arch. ges. physiol.

Alveolar carbon dioxide tension levels during pregnancy and early puerperium

J. Clin. Endocrinol.

Respiratory and acid-base changes during pregnancy

Anesthesiology

Eine Wirking des Progesterone auf die Atmung

Arch. ges. physiol.

Ueber rhythmische Schwankungen von Atmung und Korpertemperatur im Menstruationzyklus

Arch. ges. physiol.

Further investigations about respiration in the cycle of the woman

Pflügers Arch. ges. Physiol.

Weitere Untersuchungen ueber der Wirkung der Sexhormone auf die Atmung

Arch. ges. physiol.

The sensitivity of the respiratory center in pregnancy and after the administration of progesterone

Tr. A. Am. Physicians

The effect of progesterone on the respiration of patients with emphysema and hypercarbia

J. Clin. Invest.

Measurement of oxygen tension in unstirred blood with a platinum electrode

J. Appl. Physiol.

Electrodes for blood pO2 and pCO2 determination

J. Appl. Physiol.

Mechanical properties of the lung

Physiol. Rev.

Clinical study
Therapeutic use of progesterone in alveolar hypoventilation associated with obesity☆

Electrodes for blood pO₂ and pCO₂ determination