One evidence base; three stories: do opioids relieve chronic breathlessness?

Ekstrom, Magnus; Currow, David C.; Johnson, Miriam J.; Ekström, Magnus; Bajwah, Sabrina; Bland, J. Martin; Currow, David; Hussain, Jamilla; Johnson, Miriam

Abstract

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. The efficacy of low-dose systemic opioids for chronic breathlessness was questioned by the recent Cochrane review by Barnes et al We examined the reasons for this conflicting finding and re-evaluated the efficacy of systemic opioids. Compared with previous meta-analyses, Barnes et al reported a smaller effect and lower precision, but did not account for matched data of crossover trials (11/12 included trials) and added a risk-of-bias criterion (sample size). When re-analysed to account for crossover data, opioids decreased breathlessness (standardised mean differences -0.32; -0.18 to -0.47; I2=44.8%) representing a clinically meaningful reduction of 0.8 points (0-10 numerical rating scale), consistent across meta-analyses.

Citation

Ekstrom, M., Currow, D. C., Johnson, M. J., Ekström, M., Bajwah, S., Bland, J. M., …Johnson, M. (2018). One evidence base; three stories: do opioids relieve chronic breathlessness?. Thorax, 73(1), 88-90. https://doi.org/10.1136/thoraxjnl-2016-209868

• Journal Article Type: Letter
• Acceptance Date: Mar 10, 2017
• Online Publication Date: Dec 13, 2017
• Publication Date: 2018
• Deposit Date: Mar 15, 2017
• Publicly Available Date: Dec 13, 2017
• Journal: Thorax
• Print ISSN: 0040-6376
• Electronic ISSN: 1468-3296
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 1
• Pages: 88-90
• DOI: https://doi.org/10.1136/thoraxjnl-2016-209868
• Keywords: Palliative care, COPD pharmacology, Perception of asthma/breathlessness
• Public URL: https://hull-repository.worktribe.com/output/449584
• Publisher URL: http://thorax.bmj.com/content/early/2017/04/04/thoraxjnl-2016-209868
• Additional Information: This is a description of an article accepted for publication in: Thorax, 2017