Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1986 Aug;41(8):616–619. doi: 10.1136/thx.41.8.616

Oral progesterone treatment in chronic obstructive lung disease: failure of voluntary hyperventilation to predict response.

D A Morrison, A L Goldman
PMCID: PMC460407  PMID: 2947345

Abstract

Previous studies have shown that some patients with chronic obstructive lung disease and hypercapnia will respond to medroxyprogesterone with improvement in arterial blood gases. The exact mechanism of this effect is unclear but it is presumed to be a result of ventilatory stimulation. To determine whether the ability to correct arterial blood gas abnormalities by voluntary hyperventilation would predict a subsequent favourable response to progesterone, we studied 11 subjects with chronic obstructive lung disease and chronic hypercapnia. Five subjects had chronic obstructive lung disease of moderate severity with mean (SE) FEV1 1.8 (0.34) 1 maximum voluntary ventilation (MVV) 40.4 (7.16) 1/min-1, arterial oxygen tension (Pao2) 53.8 (2.40 mm Hg, and arterial carbon dioxide tension Paco2) 49.6 (3.91) mm Hg, and were able to normalise their blood gas tensions during voluntary hyperventilation (Pao2 85.4 (8.01) mm Hg; Paco2 32.8 (3.43) mm Hg). Six subjects had severe chronic obstructive lung disease with FEV1 0.77 (0.12) 1, MVV 19 (3.09) 1/min-1, Pao2 60.0 (2.89) mm Hg and Paco2 50.5 (1.38) mm Hg, and they could not significantly alter their blood gases with voluntary hyperventilation (Pao2 62.5 (3.19) mm Hg, Paco2 49.7 (1.84) mm Hg). The groups were similar in age, height, weight, and resting Pao2 and Paco2. Each subject received one month of oral placebo and one month of medroxyprogesterone acetate (Provera). 20 mg orally thrice daily, given in a randomised, double blind fashion. The groups responded similarly with a significantly higher Pao2 and lower Paco2 while having medroxyprogesterone acetate than while having placebo. Two patients with polycythaemia showed a reduction in haemoglobin concentration while taking progesterone. It is concluded that the response to medroxyprogesterone is not predictable from spirometric or blood gas changes after voluntary hyperventilation.

Full text

PDF
616

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. CULLEN J. H., BRUM V. C., REIDT W. U. The respiratory effects of progesterone in severe pulmonary emphysema. Am J Med. 1959 Oct;27:551–557. doi: 10.1016/0002-9343(59)90040-3. [DOI] [PubMed] [Google Scholar]
  2. Dolly F. R., Block A. J. Medroxyprogesterone acetate and COPD. Effect on breathing and oxygenation in sleeping and awake patients. Chest. 1983 Oct;84(4):394–398. doi: 10.1378/chest.84.4.394. [DOI] [PubMed] [Google Scholar]
  3. GILBERT R., KEIGHLEY J., AUCHINCLOSS J. H., Jr MECHANISMS OF CHRONIC CARBON DIOXIDE RETENTION IN PATIENTS WITH OBSTRUCTIVE PULMONARY DISEASE. Am J Med. 1965 Feb;38:217–225. doi: 10.1016/0002-9343(65)90175-0. [DOI] [PubMed] [Google Scholar]
  4. KORY R. C., CALLAHAN R., BOREN H. G., SYNER J. C. The Veterans Administration-Army cooperative study of pulmonary function. I. Clinical spirometry in normal men. Am J Med. 1961 Feb;30:243–258. doi: 10.1016/0002-9343(61)90096-1. [DOI] [PubMed] [Google Scholar]
  5. Lyons H. A., Huang C. T. Therapeutic use of progesterone in alveolar hypoventilation associated with obesity. Am J Med. 1968 Jun;44(6):881–888. doi: 10.1016/0002-9343(68)90088-0. [DOI] [PubMed] [Google Scholar]
  6. OTIS A. B. The work of breathing. Physiol Rev. 1954 Jul;34(3):449–458. doi: 10.1152/physrev.1954.34.3.449. [DOI] [PubMed] [Google Scholar]
  7. Rhoads G. G., Brody J. S. Idiopathic alveolar hypoventilation: clinical spectrum. Ann Intern Med. 1969 Aug;71(2):271–278. doi: 10.7326/0003-4819-71-2-271. [DOI] [PubMed] [Google Scholar]
  8. Rotsztain A., Haddad R., Canter H. G. Blood gas changes during voluntary hyperventilation in normal and disease states. Am Rev Respir Dis. 1970 Aug;102(2):205–212. doi: 10.1164/arrd.1970.102.2.205. [DOI] [PubMed] [Google Scholar]
  9. Skatrud J. B., Dempsey J. A., Bhansali P., Irvin C. Determinants of chronic carbon dioxide retention and its correction in humans. J Clin Invest. 1980 Apr;65(4):813–821. doi: 10.1172/JCI109732. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Skatrud J. B., Dempsey J. A., Iber C., Berssenbrugge A. Correction of CO2 retention during sleep in patients with chronic obstructive pulmonary diseases. Am Rev Respir Dis. 1981 Sep;124(3):260–268. doi: 10.1164/arrd.1981.124.3.260. [DOI] [PubMed] [Google Scholar]
  11. Sutton F. D., Jr, Zwillich C. W., Creagh C. E., Pierson D. J., Weil J. V. Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med. 1975 Oct;83(4):476–479. doi: 10.7326/0003-4819-83-4-476. [DOI] [PubMed] [Google Scholar]
  12. TYLER J. M. The effect of progesterone on the respiration of patients with emphysema and hypercapnia. J Clin Invest. 1960 Jan;39:34–41. doi: 10.1172/JCI104024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. West J. B. Causes of carbon dioxide retention in lung disease. N Engl J Med. 1971 Jun 3;284(22):1232–1236. doi: 10.1056/NEJM197106032842202. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES