Skip to main content

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.

Journal Article Type Review
Publication Date 2020-09
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
APA6 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
DOI https://doi.org/10.1136/bmjspcare-2020-002314
Keywords Opioids; Morphine; Breathlessness; Dyspnoea; Evidence
Publisher URL https://spcare.bmj.com/content/early/2020/07/03/bmjspcare-2020-002314

Files

Article (297 Kb)
PDF

Copyright Statement
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Technical Information
File can be made discoverable upon online publication





You might also like



Downloadable Citations

;