Opioids relieve severe shortness of breath in COPD

by Bruce Sylvester – Opioid treatment offers relief and improved quality of life to patients with advanced chronic obstructive pulmonary disease (COPD) and shortness of breath, researchers reported in the April 23 edition of CMAJ (Canadian Medical Association Journal).

The researchers evaluated physician, patient and caregiver attitudes toward opioid treatment for severe, refractory dyspnea that cannot be relieved with other treatments. They interviewed 8 patients, 12 caregivers and 28 physicians in Nova Scotia, Canada.

The patients were on recommended therapies for COPD and long-term oxygen, and had been using opioids for dyspnea for five weeks to four years.

“All patients reported that opioids provided significant improvements to their quality of life, relief of dyspnea, or both, and cited this as their main reason to continue taking opioids over the longer term,” said lead author Dr. Graeme Rocker, Dalhousie University, Halifax, Nova Scotia.

Caregivers also reported that opioid treatment led to improvements in their family quality of life and stress levels.

“Many physicians indicated uncertainty and discomfort about prescribing opioids to patients with COPD,” wrote the investigators. “Lack of guidance, confidence and experience, a fear of respiratory suppression, and concern about censure were key factors limiting their willingness to prescribe opioids in this context. However, most acknowledged that dyspnea is difficult and frustrating to manage and thus were willing to consider opioids for this purpose.”

“Discrepancies between the positive experiences of patients and family caregivers and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care,” concluded the authors. “Bridging this gap will likely require innovative educational initiatives to improve the uptake of guidelines and confidence in prescribing opioids for refractory dyspnea.”