Intravenous diuretic and vasodilator therapy reduce plasma brain natriuretic peptide levels in acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Plasma concentrations of brain natriuretic peptide (BNP) are elevated in patients with chronic obstructive pulmonary disease (COPD), and high plasma BNP levels are associated with a poor prognosis. We aimed to evaluate the effects of a diuretic and a vasodilator on plasma BNP levels and health-related quality of life (HRQOL) in patients with acute exacerbations of COPD (AECOPD).

METHODS: Forty patients with an AECOPD and high plasma BNP levels, but without any clinical evidence of cor pulmonale, were selected. The patients were randomly divided into two groups of 20 patients. In addition to standard treatment for AECOPD, the patients in group I were treated with a mild diuretic, and those in group II were treated with the diuretic and a vasodilator. Twenty patients with stable COPD were selected as a control group. Plasma BNP concentrations were measured on admission and on the third and sixth days. The patients' HRQOL was evaluated using the short-form 36-item (SF-36) questionnaire before and after treatment.

RESULTS: Plasma BNP concentrations in patients with AECOPD were significantly decreased after treatment, and this decrease was more striking in group II than in group I. There were no significant differences in SF-36 domain scores between patients with stable COPD and those with acute exacerbations who were treated with a diuretic and a vasodilator.

CONCLUSIONS: Plasma BNP levels decreased rapidly in patients with an AECOPD after therapy with a diuretic and a vasodilator, and the treatment did not impair their health status.