Respiratory Insufficiency in Postmenopausal Women: Sustained Effects of MPA

In: Respiratory

2 Sep 2014

Sustained Effects of MPA
The blood gases were reevaluated after 3- and 6-week washout periods. At the 3-week washout, PaC02 and Pa02 values remained improved in 11 and 8 patients, respectively. At 3 weeks after cessation of MPA, the mean PaC02 was still 3.0 mm Hg (95% CI, 0.75 to 4.5) or 6.1% (95% CI, 2.3 to 9.9; Fig 3) lower than baseline, whereas at 6 weeks the mean PaC02 had returned to the baseline level. The Pa02, Pa02/ PaC02 ratio (Fig 3), HCO3~, and BE (Fig 4) followed a similar sustained effect pattern, but the changes were NS. The pH changed neither on MPA nor during the washout (Fig 4).
BP Effects
The systolic BP followed a distinct sustained-effect pattern, with no change on MPA but significant lowering after a 3-week washout period (from 155.2 mm Hg at baseline to 140.5 mm Hg; average reduction, 14.8 mm Hg [95% CI, 2.6 to 27.0] or 9.8% [95% CI, 2.0 to 18.0]; Fig 5). The diastolic BP did not change during the follow-up (Fig 5). this

Adverse Effects of High-Dose MPA Therapy
Two of the 13 women had undergone a hysterectomy. Three (27%) women without hysterectomies had withdrawal bleeding after cessation of MPA and went through a gynecologic examination. A benign endometrial polyp was found to be a predisposing factor in one subject, and another had used local estrogen therapy promoting the proliferation of endometrial mucosa. In the third subject no endometrial abnormalities could be identified to predispose for withdrawal bleeding.
Some months after the termination of the present study, the observed effects on breathing were reported to the subjects on the phone. Twelve of 13 (92%) expressed their willingness to continue MPA therapy even after the trial. The subject with endometrial polyp and withdrawal bleeding preferred not to continue.
Body weight, body mass index, FEV1, FVC, the FEV-/FVC ratio, hemoglobin, and hematocrit remained constant throughout the study. Also, there was no effect of MPA on the sensation of dyspnea measured with the visual analog scale. No changes in mental disorders, headache, palpitation, swelling, tenderness of breasts, thirst, dizziness, or GI or dermatologic disorders were observed in the daily diary card questionnaire.

Figure 4. Changes in pH, BE, and HCO3— from the baseline. Changes (± SEM) are absolute for pH and BE, and as a percentage from baseline for HCO3—. The mean of baseline in pH is 7.40 and 0.97 mmol/L in BE

Figure 4. Changes in pH, BE, and HCO3 from the baseline. Changes (± SEM) are absolute for pH and BE, and as a percentage from baseline for HCO3. The mean of baseline in pH is 7.40 and 0.97 mmol/L in BE

Figure 5. Relative changes (± SEM) in systolic and diastolic BP from the baseline. Systolic BP was significantly lower (p = 0.016) at the 3-week washout.

Figure 5. Relative changes (± SEM) in systolic and diastolic BP from the baseline. Systolic BP was significantly lower (p = 0.016) at the 3-week washout.


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