0
Clinical Investigations: COPD |

Comparison of Acetazolamide and Medroxyprogesterone as Respiratory Stimulants in Hypercapnic Patients With COPD*

Michiel Wagenaar; Petra Vos; Yvonne Heijdra; Luc Teppema; Hans Folgering
Author and Funding Information

*From the Department of Pulmonary Diseases (Drs. Wagenaar, Vos, Heijdra, and Folgering), Dekkerswald, University of Nijmegen; and Department of Physiology (Dr. Teppema), Leiden University Medical Center, the Netherlands.

Correspondence to: M. Wagenaar, MD, PhD, Department of Pulmonary Diseases, Dekkerswald, University of Nijmegen, PO Box 9001, 6560 GB Groesbeek, the Netherlands; e-mail: m.wagenaar@ulc.umcn.nl



Chest. 2003;123(5):1450-1459. doi:10.1378/chest.123.5.1450
Text Size: A A A
Published online

Background: Acetazolamide and medroxyprogesterone acetate (MPA) are two respiratory stimulants that can be used in patients with stable hypercapnic COPD.

Design and methods: The effects of acetazolamide, 250 mg bid, and MPA, 30 mg bid, on daytime and nighttime blood gas values and the influences on the hypercapnic and hypoxic ventilatory and mouth occlusion pressure (P0.1) at 100 ms response were studied in a crossover design in 12 hypercapnic patients with stable COPD (FEV1, 33 ± 4% predicted [mean ± SEM]).

Results: Daytime Paco2 decreased from 47.3 ± 0.8 mm Hg (placebo) to 42.0 ± 1.5 mm Hg during acetazolamide treatment (p < 0.05) and to 42.8 ± 1.5 mm Hg during MPA treatment (p < 0.05). Daytime Pao2 improved with acetazolamide from 65.2 ± 2.3 to 75.0 ± 3.0 mm Hg (p < 0.05), whereas no significant changes were seen with MPA. Mean nocturnal end-tidal carbon dioxide tension decreased with both treatments, from 42.0 ± 2.3 to 35.3 ± 2.3 mm Hg with acetazolamide (p < 0.05) and to 34.5 ± 0.8 mm Hg with MPA (p < 0.05). The percentage of time that the nocturnal arterial oxygen saturation was < 90% was reduced significantly with acetazolamide, from 34.9 ± 10.7% to 16.3 ± 7.5% (p < 0.05). Mean nocturnal saturation did not change with MPA. Resting minute ventilation increased significantly only with MPA from 9.6 ± 0.7 to 10.8 ± 0.8 L/min (p < 0.05). The slope of the hypercapnic ventilatory response did not change during acetazolamide and MPA therapy. The hypoxic ventilatory response increased from − 0.2 ± 0.05 to − 0.4 ± 0.1 L/min/% during acetazolamide (p < 0.05) and to − 0.3 ± 0.1 L/min/% during MPA (p < 0.05). The hypoxic P0.1 response improved with acetazolamide treatment from − 0.05 ± 0.008 to − 0.15 ± 0.02 mm Hg/% (p < 0.05).

Conclusions: This study shows that acetazolamide and MPA both have favorable effects on daytime and nighttime blood gas parameters in ventilatory-limited patients with stable COPD. However, the use of acetazolamide is preferred because of its extra effect on nocturnal saturation.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543