Attitudes toward opioids for refractory dyspnea in COPD among Dutch chest physicians

Abstract

Dyspnea is the most frequently reported symptom of outpatients with advanced chronic obstructive pulmonary disease (COPD). Opioids are an effective treatment for dyspnea. Nevertheless, the prescription of opioids to patients with advanced COPD seems limited. The aims of this study are to explore the attitudes of Dutch chest physicians toward prescription of opioids for refractory dyspnea to outpatients with advanced COPD and to investigate the barriers experienced by chest physicians toward opioid prescription in these patients. All chest physicians (n = 492) and residents in respiratory medicine (n = 158) in the Netherlands were invited by e-mail to complete an online survey. A total of 146 physicians (response rate 22.5%) completed the online survey. Fifty percent of the physicians reported to prescribe opioids for refractory dyspnea in 20% or less of their outpatients with advanced COPD and 18.5% reported never to prescribe opioids in these patients. The most frequently reported barriers toward prescription of opioids were resistance of the patient, fear of possible adverse effects, and fear of respiratory depression. To conclude, Dutch chest physicians and residents in respiratory medicine rarely prescribe opioids for refractory dyspnea to outpatients with advanced COPD. This reluctance is caused by perceived resistance of the patient and fear of adverse effects, including respiratory adverse effects.

Prescription of opioids for breathlessness in end-stage COPD: a national population-based study

“…The current findings are consistent with a Dutch study that chest physicians rarely prescribed opioids for refractory breathlessness to outpatients with advanced COPD 23. The most frequent barriers to opioid prescription were the physician’s fear of possible serious adverse events, including respiratory depression and resistance of some patients 23.…”

“…The most frequent barriers to opioid prescription were the physician’s fear of possible serious adverse events, including respiratory depression and resistance of some patients 23. Although more research is needed, the evidence to date supports the safety of low-dose opioids for symptomatic treatment in advanced diseases including COPD.…”

Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

“…In our study, the most commonly reported opioid concern was the risk of respiratory depression (25%). This is comparable to the Dutch survey in which 20% of doctors were worried about opioid induced respiratory depression . Meanwhile other small studies, including qualitative data, have reported concern regarding respiratory depression to be much higher, nearer 56–62% of doctors surveyed .…”

The association between different opioid doses and the survival of advanced cancer patients receiving palliative care

“…Another study that attempted to identify the barriers to cancer pain management in Taiwan demonstrated that informed family caregivers of advanced cancer patients had concerns about reporting pain and administering opioids, particularly as they related to disease progression and possible side effects [7]. Additionally, previous studies on the physician’s attitude toward prescribing opioids for dyspnea showed that the most frequently-reported barriers regarding the prescription of opioids were the resistance of the patient, fear of potential adverse effects, and fear of respiratory depression [6, 8]. A study in the Netherlands on the perceptions of physicians concerning opioid use and the survival of the patient showed that physicians more often took hastening death into account when they gave higher doses of opioids when the patient experienced more severe symptoms and with female patients [9].…”