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Nebulised furosemide in acute adult asthma
  1. Zui-Shen Yen, Emergency Physician,
  2. Shyr-Chyr Chen, Emergency Physician
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; s.carley1btinternet.com

    Abstract

    A short cut review was carried out to establish whether the addition of nebulised furosemide to beta-agonist therapy improves outcomes in acute asthma. Altogether 87 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. A further relevant paper was found on scanning the references of these papers. The author, date and country of origin, patient group studied, study type, relevant outcome, results, and study weaknesses of the best papers are tabulated. There is currently insufficient evidence to support the routine addition of nebulised furosemide to standard beta agonist therapy in acute asthma in adults

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    Report by Zui-Shen Yen, Emergency PhysicianChecked by Shyr-Chyr Chen, Emergency Physician

    Three part question

    In [an adult with asthma] is [nebulised beta agonist with nebulised furosemide better than nebulised beta agonist alone] at [improving airflow and reducing morbidity]?

    Clinical scenario

    A known asthmatic adult patient is brought into the emergency department with signs consistent with acute asthma. Little improvement is noted with nebulised beta agonist therapy. You wonder if adjunctive nebulised furosemide would provide any benefit.

    Search strategy

    Medline 1966–12/04 and Embase: Drugs & Pharmacology 1980–01/03 using the OVID interface, The Cochrane Library, Issue 2, 2005. Medline: [(exp furosemide OR furosemide$.mp OR lasix$.mp) AND (nebuli$.mp OR vapori$.mp OR inhal$.mp OR aerosoli$.mp) AND (exp asthma OR exp asthma, exercise-induced OR asthma$.mp OR exp bronchial spasm OR bronchial spasm$.mp OR bronchospasm$.mp)] LIMIT to human AND English language. Embase: [(exp furosemide OR furosemide$.mp OR lasix$.mp) AND (nebuli$.mp OR vapori$.mp OR inhal$.mp OR aerosoli$.mp) AND (exp asthma OR exp exercised induced asthma OR exp allergic asthma OR exp occupational asthma OR exp bronchospasm OR bronchial spasm$.mp OR bronchospasm$.mp)] LIMIT to human AND English language. Cochrane Library: “furosemide”.

    Search outcome

    Altogether 87 papers from Medline and 156 from Embase were found of which two were considered to be original research of high quality (randomised controlled trials) and relevant to the topic of interest. A further reference was found after scanning of paper references. These three papers are summarised in table 1. Thirty four papers were found in the Cochrane Library, none of which were relevant to the three part question.

    Table 1

    Comment(s)

    A number of mechanisms have been postulated to explain the bronchodilating effect of nebulised furosemide, including: (1) induction of relaxant prostaglandins; (2) blockade of mediator production from inflammatory cells; (3) regulation of ion exchange in the airway epithelium. Of the few randomised controlled studies that relate to the efficacy of nebulised furosemide in the treatment of acute adult asthma, samples remain small and conflicting results persist. More large scale studies are needed to determine whether nebulised furosemide has any therapeutic benefit in acute adult asthma.

    CLINICAL BOTTOM LINE

    There is currently insufficient evidence to support the routine addition of nebulised furosemide to standard beta agonist therapy in acute asthma in adults.

    Report by Zui-Shen Yen, Emergency PhysicianChecked by Shyr-Chyr Chen, Emergency Physician

    References

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