In: Respiratory23 Aug 2014
Sustained Improvement of Gas Exchange With Short-term Medroxyprogesterone Acetate
TT ypercapnic respiratory failure is the end stage and predictor of poor prognosis in severe lung disease. Nasal intermittent positive-pressure ventilation (NIPPV) has been suggested to control chronic respiratory failure caused by COPD. However, the efficacy of NIPPV in terms of quality of life or survival remains to be determined. Therefore, NIPPV is not recommended as the first-line therapy for chronic respiratory failure in stable COPD.
Long-term oxygen therapy (LTOT) improves oxygenation and the prognosis of COPD with chronic respiratory failure. In a subgroup of patients, LTOT cannot be used because of aggravation of CO2 retention. Both NIPPV and LTOT require the cooperation of the patient, expensive devices, efficacy monitoring, and technical maintenance. Click Here
In patients with clinically stable COPD, progestins improve arterial hypoxemia and hypercapnia as well as increase arterial pH. Progestins act through progesterone receptors. Marked variability in individual responses to progestins suggests differences in number, binding capacity, or function of progesterone receptors. Despite the fact that progesterone is a female hormone and has feminizing effects, it is surprising that the above-mentioned studies include 124 men but only 3 women.
It is generally accepted that the ventilatory effects subside within 14 days after cessation of medroxyprogesterone acetate (MPA). However, there is some evidence suggesting that patients with stable hypercapnia may continue to decrease their PaC02 even after 1 week of cessation of MPA.
The purposes of the present study were to evaluate the degree and duration of MPA effect as well as the tolerability in postmenopausal women with chronic respiratory insufficiency.
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