Randomised, placebo controlled trial of nebulised furosemide for breathlessness in patients with cancer.
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.


METHODS
Patients with primary or secondary lung cancer and a Dyspnoea Exertion Scale score of >or=3 were recruited. Following familiarisation, patients received either nebulised furosemide 40 mg or nebulised 0.9% saline under double blind conditions or no treatment, in random order on 3 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
15 patients took part. There were no differences between furosemide, saline and no treatment in the outcomes of the number reading test (eg, mean number read per breath was 6.7, 6.4 and 6.7, respectively) or arm exercise test (eg, 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 forced expiratory volume in 1 s and forced vital capacity 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. Listed on the National Research Register (N0170118249) and the UK Clinical Research Network Portfolio Database (1428).
Wilcock
A
A
Department of Palliative Medicine, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK. andrew.wilcock@nottingham.ac.uk
Walton
A
A
Manderson
C
C
Feathers
L
L
El Khoury
B
B
Lewis
M
M
Chauhan
A
A
Howard
P
P
Bell
S
S
Frisby
J
J
Tattersfield
A
A
D000280:Administration, Inhalation; D000368:Aged; D018592:Cross-Over Studies; D004232:Diuretics / Q000008:administration & dosage*; D004311:Double-Blind Method; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005080:Exercise Test; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D013147:Spirometry
D004232:Diuretics; D005665:Furosemide