Inhalation through a nebulizer of furosemide, a diuretic used for hypertension, alleviated the sensation of severe breathlessness (dyspnea) caused by exercise testing in patients with moderate to severe chronic obstructive pulmonary disease (COPD. The investigators performed a double-blind, randomized crossover study on 19 COPD patients to investigate the degree of and potential relief from dyspnea during exercise. According to the authors, dyspnea is a hallmark symptom of COPD and represents a major cause of patient disability and anxiety. It also is the reason most patients with COPD seek medical attention. (COPD patients have persistent obstruction of the airways associated with either emphysema or bronchitis. Both illnesses are caused by years of cigarette smoking. In the U.S., the disease is the fourth leading cause of death.) In addition to the demonstrated improvement in the sensation of breathlessness during exercise training, the investigators also found a small but statistically significant improvement in the results of a major lung function test after patients had inhaled furosemide. The study appears in the first issue for May 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
"GENTLE VENTILATION" STUDY MAY PROVIDE A WAY TO AVOID SERIOUS VENTILATOR INJURY IN VERY PREMATURE INFANTS
Nasal continuous positive airway pressure is an effective noninvasive technique that minimized lung injury to premature baboons that are at risk of developing a serious lung problem, bronchopulmonary dysplasia, caused by mechanical ventilation. Researchers significantly reduced the need for mechanical ventilation in 5 very immature baboons by combining prophylactic surfactant with nasal continuous airway pressure (nCPAP) therapy. The researchers said that they have developed an immature primate model for neonatal bronchopulmonary dysplasia (BPD) that approximates the premature infant in terms of lung development and the need for long-term ventilator support. (BPD lung injury in tiny premature infants results from stretching of the air sacs by the high pressure needed to inflate the lungs using mechanical ventilation and by the high concentration of oxygen provided. As a result, the lungs become inflamed, and fluid tends to accumulate.) All of the baboon infants were delivered by cesarean section at 125 days. Term for a baboon infant is 185 days. Lung development in the baboon at 125 days is similar to human infants at 24 to 26 weeks gestation. The researchers indicated that nasal CPAP did not cause an arrest in the development of the tiny air sacs of the lung (alveoli) where the exchange of oxygen and carbon dioxide takes place. They said that their findings support the notion that the CPAP-treated lung can continue to form alveoli over the 2-year time period that alveolar development persists in human babies. The study appears in the first issue for May 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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Journal
American Journal of Respiratory and Critical Care Medicine