A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study

Verberkt, Cornelia A.; Everdingen, M.H.J. van den Beuken-van; Franssen, Frits M.E.; Dirksen, Carmen D.; Schols, Jos M. G. A.; Wouters, Emiel F.M.; Janssen, Daisy J.A.

doi:10.1016/j.cct.2016.01.007

Cited by 15 publications

(22 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The meta-analysis showed an increase in PaCO 2 of 0.27 (0.09-0.46) kPa. Although this increase is statistically significant, it is not considered to be clinically relevant [85]. Indeed, the pooled mean±SD PaCO 2 was 5.35±1.08 kPa, so the mean difference in PaCO 2 was only 25% of the standard deviation.…”

Section: Discussionmentioning

confidence: 89%

“…Of the three other studies, two have respiratory adverse effects as a secondary outcome and the sample size calculation will therefore probably not be based on this outcome. Only the MORDYC (Morphine for Dyspnea in COPD) study focuses primarily on respiratory adverse effects and the sample size calculation is based on the PaCO 2 [85]. This study will add valuable information about the occurrence of respiratory adverse effects.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2017

View full text Add to dashboard Cite

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. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.PubMed, Embase, the 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.We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08-0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).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.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Hence, in China, morphine is considered to be the contraindicated for dyspnea (due to the risk of respiratory depression). Additionally, although morphine has been prohibited to treat COPD for a long time, it is presently the first-line drug used to alleviate breathlessness for patients with COPD (Zebraski et al 2000; Mahler et al 2010; Verberkt et al 2016). Increasing numbers of clinical studies support the notion that morphine should be a first-line drug that is effective and safe for the treatment of dyspnea in terminal cancer.…”

Section: Discussionmentioning

confidence: 99%

Morphine versus methylprednisolone or aminophylline for relieving dyspnea in patients with advanced cancer in China: a retrospective study

Tian

Wang

et al. 2016

SpringerPlus

View full text Add to dashboard Cite

ContextDyspnea is one of the most common and distressing symptoms that occurs in terminal cancer patients. However, there are no existing treatment guidelines for this condition in China.ObjectiveThis single-center, retrospective, observational study aimed to compare the efficacy of using morphine, methylprednisolone, or aminophylline to relieve the symptom of breathlessness in patients with advanced malignant tumors and to investigate the safety of these regimens during the treatment of dyspnea.MethodsBetween August 2011 and January 2015 we retrospectively reviewed the medical records of 343 terminally ill cancer patients with dyspnea who received morphine, methylprednisolone, or aminophylline. The therapeutic effect of each treatment by means of visual analogue scale (VAS) scores was assessed and compared. Statistical methods included Chi square and analysis of variance tests. Differences were considered significant when P < 0.05.ResultsVAS scores after treatment were (16.82 ± 10.89), (25.72 ± 15.03), and (31.95 ± 16.00) points in the morphine, methylprednisolone, and aminophylline group, respectively. These differences were found to be significantly different (P < 0.05). The effectiveness ratings were 86.44, 62.16, and 49.12%, respectively (P < 0.05).ConclusionsWe found that morphine subcutaneous injection for advanced cancer patients with dyspnea was safe and typically more effective than methylprednisolone or aminophylline. Therefore, morphine treatment could significantly improve the quality of life in terminal cancer patients with short life expectancies who are experiencing shortness of breath.

show abstract

“…A recent overview of Cochrane reviews of opioid therapy for chronic pain found no case of respiratory depression, sleep apnoea or sleep-disordered breathing [15]. Nevertheless, while this Cochrane review did not focus on patients with COPD, we agree that measurement of overnight oximetry is needed to assess adverse effects of opioids for breathlessness and therefore we included pulse oximetry in the MORDYC study [16], for which we are currently collecting data.…”

mentioning

confidence: 99%

“…Only one of these cases required ventilator support and occurred in a patient treated with high-dose morphine [22]. However, since the effects of opioid treatment for chronic breathlessness have never been examined in a long-term and well-powered randomised controlled trial, the MORDYC study [16] and BEAMS study [23] are being conducted. The MORDYC study primarily focuses on the effect of slow-release morphine on respiratory outcomes.…”

mentioning

confidence: 99%

Adverse respiratory effects of opioids for chronic breathlessness: to what extent can we learn lessons from chronic pain?

et al. 2018

View full text Add to dashboard Cite

We would like to thank K.T.S. Pattinson and colleagues for their interest in our review and their comprehensive comments [1]. We agree that the quality of the included studies was low, and the studies were small and not designed to examine the safety of opioids, as stated in our discussion [2]. Indeed, respiratory depression was not included as an outcome in over half of the studies. Of note, in the 25 studies that did include the outcome, only 11 stated a definition. Therefore, we recommended in our review to include "a common respiratory outcome set in all trials of opioids for breathlessness, so that a more robust synthesis could be conducted". Although chemoreflex response is useful in laboratory research, measurement of blood gases remains the basis for evaluation in clinical practice, with the assessment of arterial blood gases being more reliable than the assessment of capillary blood gases [3] or transcutaneous measurement [4].

show abstract

A randomized controlled trial on the benefits and respiratory adverse effects of morphine for refractory dyspnea in patients with COPD: Protocol of the MORDYC study

Cited by 15 publications

References 46 publications

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

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

Morphine versus methylprednisolone or aminophylline for relieving dyspnea in patients with advanced cancer in China: a retrospective study

Adverse respiratory effects of opioids for chronic breathlessness: to what extent can we learn lessons from chronic pain?

Contact Info

Product

Resources

About