Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?
A. Reducing fluid volume reduces oxygen demand.
B. Reducing fluid volume improves clients’ mobility.
C. Restricting fluid volume reduces sputum production.
D. Reducing fluid volume improves respiratory function.
Correct Answer: A. Reducing fluid volume reduces oxygen demand.
Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear airways. As a result, diuretic drugs may be prescribed in COPD for a variety of reasons: pulmonary hypertension and cor pulmonale; pulmonary edema; systemic hypertension; and empirically for severe dyspnoea refractory to maximal conventional therapy.
Option B: Diuretic drugs may theoretically improve respiratory health outcomes in COPD through several possible mechanisms. Diuretics may reduce pulmonary hypertension (either subclinical or overt) and cor pulmonale by decreasing preload to the heart and they can also reduce pulmonary edema. The presence of pulmonary hypertension in COPD is associated with increased mortality risk 6 and symptoms related to excessive fluid overload may lead an individual with COPD to present to hospital for acute care
Option C: Diuretic drugs may theoretically improve respiratory health outcomes among individuals with chronic obstructive pulmonary disease (COPD), but they may also contribute to respiratory harm. There are minimal and conflicting data regarding the potential respiratory effects of systemic diuretic drugs among individuals with COPD.
Option D: Reducing fluid volume won’t improve respiratory function but may improve oxygenation. Acetazolamide inhibits the renal carbonic anhydrase enzyme, which reduces serum bicarbonate and contributes to metabolic acidosis, which in turn increases minute ventilation through peripheral and central chemoreceptor stimulation. By stimulating minute ventilation and improving gas exchange, acetazolamide may mitigate dyspnoea crises and respiratory exacerbations among individuals with COPD.
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