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Opioids for breathlessness: a narrative review

Currow, David C.; Johnson, Miriam J.; Pollack, Allan; Ferreira, Diana H. ; Kochovska, Slavica ; Ekström, Magnus ; Harrison, Christopher

Authors

David C. Currow

Allan Pollack

Diana H. Ferreira

Slavica Kochovska

Magnus Ekström

Christopher Harrison



Abstract

ABSTRACT
Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of management and should be optimised prior to use of opioid medication. Opioids are being implemented variably in practice for chronic breathlessness. This narrative review summarises the evidence defining current opioids for breathlessness best practice and identifies remaining research gaps.
There is level 1a evidence to support the use of opioids for breathlessness. The best evidence is for 10mg to 30mg daily de novo low dose oral sustained-release morphine in opioid-naïve patients. This should be considered the current standard of care following independent, regulatory scrutiny by one of the world’s therapeutics regulatory bodies.
Optimal benefits are seen in steady state, however, there are few published data about longer term benefits or harms. Morphine-related adverse events are common but mostly mild and self-limiting on withdrawal of drug. Early and meticulous management of constipation, nausea and vomiting is needed particularly in the first week of administration. Serious adverse events are no more common than placebo in clinical studies. Observational studies in severe chronic lung disease do not show excess mortality or hospital admission in those taking opioids. We have no long term data on immune or endocrine function.
There are promising data regarding prophylaxis for exertion-related breathlessness, but given the risks associated with transmucosal fentanyl, caution is needed with regard to clinical use pending longer-term, robust safety data.

Citation

Currow, D. C., Johnson, M. J., Pollack, A., Ferreira, D. H., Kochovska, S., Ekström, M., & Harrison, C. (2020). Opioids for breathlessness: a narrative review. BMJ Supportive & Palliative Care, 10(3), 287-295. https://doi.org/10.1136/bmjspcare-2020-002314

Journal Article Type Review
Acceptance Date Jun 3, 2020
Online Publication Date Jul 3, 2020
Publication Date 2020-09
Deposit Date Jun 4, 2020
Publicly Available Date Jul 3, 2020
Journal BMJ supportive & palliative care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 10
Issue 3
Pages 287-295
DOI https://doi.org/10.1136/bmjspcare-2020-002314
Keywords Opioids; Morphine; Breathlessness; Dyspnoea; Evidence
Public URL https://hull-repository.worktribe.com/output/3515585
Publisher URL https://spcare.bmj.com/content/early/2020/07/03/bmjspcare-2020-002314

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