Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Verberkt, Cindy A.; van den Beuken-van Everdingen, Marieke H.J.; Schols, Jos M.G.A.; Datla, Sushma; Dirksen, Carmen D.; Johnson, Miriam J.; van Kuijk, Sander M.J.; Wouters, Emiel F.M.; Janssen, Daisy J.A.

Abstract

Background: Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. Aim: To systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness. Methods: Pubmed, Embase, Cochrane central register of controlled trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible. Results: We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in partial pressure of carbon dioxide (0.27 kPa; 95% CI 0.08 to 0.45) and no significant change in partial pressure of oxygen and oxygen saturation (both p>0.05). Non-serious respiratory depression (definition variable/not stated) was described in 4/1064 patients. One cancer patient pre-treated with morphine for pain needed temporary respiratory support following nebulized morphine for breathlessness (single case study). Conclusions: We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.

Citation

Verberkt, C. A., van den Beuken-van Everdingen, M. H., Schols, J. M., Datla, S., Dirksen, C. D., Johnson, M. J., van Kuijk, S. M., Wouters, E. F., & Janssen, D. J. (2017). Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis. European respiratory journal, 50(5), 1701153. https://doi.org/10.1183/13993003.01153-2017

• Journal Article Type: Article
• Acceptance Date: Aug 18, 2017
• Online Publication Date: Nov 22, 2017
• Publication Date: Nov 1, 2017
• Deposit Date: Aug 23, 2017
• Publicly Available Date: May 2, 2019
• Journal: European respiratory journal
• Print ISSN: 0903-1936
• Electronic ISSN: 1399-3003
• Publisher: European Respiratory Society
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 5
• Article Number: ARTN 1701153
• Pages: 1701153
• DOI: https://doi.org/10.1183/13993003.01153-2017
• Keywords: Breathlessness, Opioids
• Public URL: https://hull-repository.worktribe.com/output/454199
• Publisher URL: http://erj.ersjournals.com/content/50/5/1701153
• Additional Information: This is a description of an article accepted for future publication in European respiratory journal. The full text is not currently available in this repository.
• Contract Date: Dec 12, 2017