Buccal Hydromorphone Syrup for Managing Dyspnea in Idiopathic Pulmonary Fibrosis

Abstract

Context: Dyspnea is a highly distressing symptom that characterizes idiopathic pulmonary fibrosis (IPF), a common idiopathic interstitial lung disease (ILD) with a high symptom burden, poor quality of life, and early mortality. Though opioids are mentioned in guidelines for dyspnea management, guidance on how and when to initiate opioids is lacking. Different pharmacologic strategies are needed to address different types of dyspnea (baseline, incident, and crisis). Due to a longer onset of action, the oral route (swallowed) may be less effective for prevention of incident dyspnea or for rapid relief of crisis dyspnea, prompting the use of alternative drug delivery strategies for self-management. We inadvertently discovered the efficacy of buccal administration of low dose, low volume hydromorphone oral syrup for dyspnea management in ILD, which has not been previously reported in the literature. Case Series: We describe our approach to dyspnea assessment and management in IPF, including use of the Multidimensional Dyspnea Scale (MDDS), a novel instrument yet to be validated that we developed to better identify and categorize dyspnea into the types experienced by a patient with IPF over the course of a day. We then describe how buccal hydromorphone oral syrup is initiated and titrated for dyspnea management in 3 patients at different points in their disease trajectory. Conclusion: Buccal hydromorphone oral syrup is effective for dyspnea management across the spectrum of IPF. When integrated into a patient-centered algorithm for symptom assessment and management, it allows for rapid and easy self-management of dyspnea by patients and their caregivers.

Hydromorphone Mitigates Cardiopulmonary Bypass-Induced Acute Lung Injury by Repressing Pyroptosis of Alveolar Macrophages

“…Several narcotics, such as dexmedetomidine, sevoflurane, and levoflurane, can be used for protection from inflammation (38)(39)(40). In particular, Hyd combined with curcumin is reported to reduces the releases of IL-1β, TNF-α, and NF-κB in rats with formaldehyde-triggered inflammatory pain (14), suggesting its anti-inflammatory property. Therefore, with future endeavors, we will evaluate the roles of Hyd in the transmigration and activity of neutrophils and inflammatory factors so as to complete the regulatory mechanism of Hyd in ALI.…”

“…Because of the superior analgesic effect, Hyd is broadly used in the clinical treatments of gynecological, pediatric, and oncological departments (11)(12)(13). Oral administration of Hyd can manage dyspnea after idiopathic pulmonary fibrosis (14). In addition, Hyd is demonstrated to protect against pulmonary inflammation and complications (15), and Hyd possesses a palliative effect on lung injury triggered by CO 2 pneumoperitoneum (16).…”