title: Nebulised furosemide in the palliation of dyspnoea in cancer: a systematic review.
abstract: BACKGROUND
  Dyspnoea is experienced by approximately two-thirds of cancer patients at the end-of-life. Despite the use and assessment of various interventions, palliation of dyspnoea poses a clinical challenge. The benefit of nebulised furosemide in the palliation of dyspnoea among cancer patients remains uncertain. This systematic review was conducted to study the effectiveness of nebulised furosemide for dyspnoea in cancer, to ascertain the most appropriate dose and adverse effects, and to quantify the effects on respiratory rate, oxygenation status, observer-rated dyspnoea and opioid dose.
  
  
  METHODS
  A systematic literature search of four databases (Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials database and CINAHL) was carried out to identify randomised controlled trials (RCTs) on the effectiveness of nebulised furosemide for dyspnoea in cancer patients.
  
  
  RESULTS
  The review identified 91 articles of which two RCTs met the inclusion criteria. The included RCTs had sample sizes of 7 and 15, respectively. Neither of the RCTs showed an improvement in dyspnoea with nebulised furosemide. Meta-analysis was not possible as the RCTs measured different domains of dyspnoea using different tools. Neither RCT highlighted significant adverse effects. Other outcomes of interest were not studied in the RCTs.
  
  
  CONCLUSIONS
  Evidence from this review, which is limited by the small number of RCTs and small sample size, does not show benefit with nebulised furosemide for the alleviation of dyspnoea in cancer. Adequately powered multicentre double-blinded RCTs are warranted to further define the potential role of this drug in the palliation of dyspnoea in advanced cancer.
authors.affiliation: Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Jeba
authors.affiliation: Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Reena
authors.initials: R
authors.lastname: George
authors.affiliation: Department of Palliative Medicine, Velindre Hospital, Cardiff, Wales, UK.
authors.forename: Nikki
authors.initials: N
authors.lastname: Pease
keywords: Nebulised Furosemide; Palliation; Randomised Controlled Trials; Systematic Review