Drugs & Therapy Perspectives

, Volume 30, Issue 8, pp 294–297 | Cite as

Consider opioid therapy for chronic refractory breathlessness

Disease Management
First Online:
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Abstract

Treatment for chronic breathlessness should be considered only when management of the underlying disease has been fully optimized. Opioids are indicated as first-line therapy, as this is the only class of drugs that has demonstrated clear clinical benefits in patients with chronic refractory breathlessness. Oral and parenteral, but not nebulized, delivery of opioids has been shown to be effective. Data plainly indicating that benzodiazepines or oxygen have therapeutic benefits in treating this condition are currently lacking.

Keywords

Chronic Obstructive Pulmonary Disease Morphine Visual Analogue Scale Interstitial Lung Disease Severe Chronic Obstructive Pulmonary Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Disclosure

This article was adapted from Drugs 2014;74:1–6 [1]. The preparation of these articles was not supported by any external funding.

References

  1. 1.
    Currow DC, Ekstrom M, Abernethy AP. Opioids for chronic refractory breathlessness: right patient, right route? Drugs. 2014;74(1):1–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Currow DC, Plummer JL, Crockett A, et al. A community population survey of prevalence and severity of dyspnea in adults. J Pain Symptom Manage. 2009;38(4):533–45.PubMedCrossRefGoogle Scholar
  3. 3.
    Frostad A, Soyseth V, Haldorsen T, et al. Respiratory symptoms and 30 year mortality from obstructive lung disease and pneumonia. Thorax. 2006;61(11):951–6.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Wiseman R, Rowett D, Allcroft P, et al. Chronic refractory dyspnoea: evidence based management. Aust Fam Physician. 2013;42(3):137–40.PubMedGoogle Scholar
  6. 6.
    Evans KC. Cortico-limbic circuitry and the airways: insights from functional neuroimaging of respiratory afferents and efferents. Biol Psychol. 2010;84(1):13–25.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Gandevia SC, Macefield G. Projection of low-threshold afferents from human intercostal muscles to the cerebral cortex. Respir Physiol. 1989;77(2):203–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson MJ, Bland JM, Oxberry SG, et al. Clinically important differences in the intensity of chronic refractory breathlessness. J Pain Symptom Manage. 2013;46(6):957–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Jennings AL, Davies AN, Higgins JP, et al. A systematic review of the use of opioids in the management of dyspnoea. Thorax. 2002;57(11):939–44.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Abernethy AP, Currow DC, Frith P, et al. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327(7414):523–8.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Currow DC, McDonald C, Oaten S, et al. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011;42(3):388–99.PubMedCrossRefGoogle Scholar
  12. 12.
    Currow DC, Quinn S, Greene A, et al. The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea. J Palliat Med. 2013;16(8):881–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Banzett RB, Adams L, O’Donnell CR, et al. Using laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response. Am J Respir Crit Care Med. 2011;184(8):920–7.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Mahler DA, Murray JA, Waterman LA, et al. Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD. Eur Respir J. 2009;33(4):771–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Gifford AH, Mahler DA, Waterman LA, et al. Neuromodulatory effect of endogenous opioids on the intensity and unpleasantness of breathlessness during resistive load breathing in COPD. COPD. 2011;8(3):160–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Shohrati M, Ghanei M, Harandi AA, et al. Effect of nebulized morphine on dyspnea of mustard gas-exposed patients: a double-blind randomized clinical trial study. Pulm Med. 2012;2012:610921.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Jensen D, Alsuhail A, Viola R, et al. Inhaled fentanyl citrate improves exercise endurance during high-intensity constant work rate cycle exercise in chronic obstructive pulmonary disease. J Pain Symptom Manage. 2012;43(4):706–19.PubMedCrossRefGoogle Scholar
  18. 18.
    Simon ST, Higginson IJ, Booth S, et al. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2010(1):CD007354.Google Scholar
  19. 19.
    Jensen D, Amjadi K, Harris-McAllister V, et al. Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD. Thorax. 2008;63(7):606–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Ong KC, Kor AC, Chong WF, et al. Effects of inhaled furosemide on exertional dyspnea in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(9):1028–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Cranston JM, Crockett A, Currow D. Oxygen therapy for dyspnoea in adults. Cochrane Database Syst Rev. 2008(3):CD004769.Google Scholar
  22. 22.
    Uronis H, McCrory DC, Samsa G, et al. Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011(6):CD006429.Google Scholar
  23. 23.
    Uronis HE, Currow DC, McCrory DC, et al. Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis. Br J Cancer. 2008;98(2):294–9.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Ben-Aharon I, Gafter-Gvili A, Leibovici L, et al. Interventions for alleviating cancer-related dyspnea: a systematic review and meta-analysis. Acta Oncol. 2012;51(8):996–1008.PubMedCrossRefGoogle Scholar
  25. 25.
    Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376(9743):784–93.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.AdisNorth ShoreNew Zealand

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