Respiratory Insufficiency in Postmenopausal Women: Results

In: Respiratory

31 Aug 2014

Respiratory Insufficiency in Postmenopausal Women: ResultsThirteen of 14 patients completed the trial. One subject discontinued because of fever and viral respiratory tract infection after her second visit, Serum creatinine, WBC count, prolactin, estradiol, progesterone, TSH, SHBG, LH, and FSH were in the normal range at baseline, and serum lipids were within the inclusion criteria, One subject had mild anemia (hemoglobin, 115 g/L; reference range, 117 to 153 g/L) and another had mild polycythemia (hemoglobin, 162 g/L; hematocrit, 0.49; upper limit of normal range, 0.47). generic doxycycline

The reference values of our laboratory were 33.8 to 45.0 mm Hg for Paco2 and 75.0 to 105.0 mm Hg for Pa02. At baseline, 5 of 13 patients (38%) had Paco2 > 45 mm Hg and 11 (85%) had Pao2 < 75 mm Hg. In four patients PaC02 and Pa02 were simultaneously beyond the reference ranges. After the 2-week treatment, the mean concentration of MPA was 4.33 ng/mL (range, 2.28 to 8.39 ng/mL). After a 3-week washout MPA was under the detection limit in three patients, and in the other 10 the mean concentration was 0.06 ng/mL (range, 0.032 to 0.196 ng/mL). After a 6-week washout, MPA was not detected in any subject. Changes in the blood gases did not correlate with the serum concentrations of MPA.
Immediate Effects of MPA on Gas Exchange
Compared with baseline, MPA improved the PaC02 values in 12 (Fig 2) and Pa02 in 11 of 13 patients. MPA reduced the mean PaC02 from 42.8 ± 4.88 mm Hg (mean ± SD) to 36.8 ± 5.25 mm Hg. The average reduction was 6.3 mm Hg (95% confidence interval [CI], 4.5 to 8.2) or 14.7% (95% CI, 9.3 to 20.1; Table 3 and Fig 3). The mean HCO3 was reduced from 25.3 to 22.6 mmol/L (average decrease, 2.6 mmol/L; 95% CI, 1.5 L to 3.7) and base excess (BE) from 0.97 to —2.23 mmol/L (average decrease, 3.2 mmol/L; 95% CI, 1.96 to 4.4). The mean Pa02 at baseline was 71.2 mm Hg and 76.5 mm Hg on MPA, the average change of 5.2 mm Hg or 8.5% being statistically not significant (NS; Fig 3). The Pa02/PaC02 ratio, representing the combined effect on gas exchange, improved 28.5% (from 11.8 to 45.1) on MPA (Fig 3).

Table 3—Arterial Blood Gas Values (N = 13)

Baseline Placebo MPA p Value Washout (3 wk) p Value Washout (6 wk) p Value
ph 7.40 (0.03) 7.39 (0.03) 7.39 (0.03) NS 7.41 (0.02) NS 7.39 (0.02) NS
Pc02, mm Hg 42.8 (4.88) 42.8 (5.02) 36.8 (5.25) < 0.001 40.5 (4.65) < 0.001 42.8 (4.80) NS
P02, mm Hg 71.2 (9.15) 69.0 (7.72) 76.5 (10.8) NS 74.2 (13.6) NS 70.5 (10.1) NS
HCO3, mmol/L 25.3(1.76) 25.1 (1.59) 22.6 (2.47) < 0.001 24.6 (5.32) NS 24.9 (2.45) NS
BE, mmol/L 0.97 (2.04) 0.79 (1.79) —2.23 (3.00) < 0.001 0.22 (1.80) NS 0.61 (2.78) NS

Figure 2. Number of patients and degree of improvement in Paco2 on MPA and after a 3-week washout. All except one improved at least 4.5 mm Hg on MPA. Even after a 3-week washout, 6 of 13 subjects maintained their Paco2 at least 3.0 mm Hg lower than at baseline.

Figure 2. Number of patients and degree of improvement in Paco2 on MPA and after a 3-week washout. All except one improved at least 4.5 mm Hg on MPA. Even after a 3-week washout, 6 of 13 subjects maintained their Paco2 at least 3.0 mm Hg lower than at baseline.

Figure 3. Changes (± SEM) in Pa02, Pac02, and Pa02/Pac02 ratio on MPA and after 3- and 6-week washouts. Changes are percentages from the baseline. *** = p < 0.001.

Figure 3. Changes (± SEM) in Pa02, Pac02, and Pa02/Pac02 ratio on MPA and after 3- and 6-week washouts. Changes are percentages from the baseline. 


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