Opioids for Dyspnea in Chronic Obstructive Pulmonary Disease: Short on the Details

Vozoris, Nicholas T.

doi:10.1164/rccm.202008-3333le

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…16 Additionally, this systematic review did not include newly published RCTs with higher study quality and larger sample sizes than previous studies. [20][21][22][23][24] Furthermore, the effectiveness of opioids in treating dyspnoea of COPD varies depending on factors such as different doses, types and courses of treatment. 13 In clinical practice, opioids have not been commonly prescribed to alleviate dyspnoea in COPD, primarily due to concerns about adverse events.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

Liu,

Xiao,

et al. 2023

Palliat Med

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Background: Opioids are recommended to treat advanced refractory dyspnoea despite optimal therapy by the American Thoracic Society clinical practice guidelines, while newly published randomised controlled trials of opioids in chronic obstructive pulmonary disease yield conflicting results. Aim: This study aimed to evaluate the effectiveness and safety of opioids for patients with chronic obstructive pulmonary disease. Design: Systematic review and meta-analysis (PROSPERO CRD42021272556). Data sources: Databases of PubMed, EMBASE and CENTRAL were searched from inception to 2022 for eligible randomised controlled trials. Results: Twenty-four studies including 975 patients, were included. In cross-over studies, opioids improved breathlessness (standardised mean difference, −0.43; 95% CI, −0.55 to −0.30; I2 = 18%) and exercise endurance (standardised mean difference, 0.22; 95% CI, 0.02–0.41; I2 = 70%). However, opioids failed to improve dyspnoea (standardised mean difference, −0.02; 95% CI, −0.22 to 0.19; I2 = 39%) and exercise endurance (standardised mean difference, 0.00; 95% CI, −0.27 to 0.27; I2 = 0%) in parallel control studies that administered sustained-release opioids for more than 1 week. The opioids used in most crossover studies were short-acting and rarely associated with serious adverse effects. Only minor side effects such as dizziness, nausea, constipation and vomiting were identified for short-acting opioids. Conclusions: Sustained-release opioids did not improve dyspnoea and exercise endurance. Short-acting opioids appeared to be safe, have potential to lessen dyspnoea and improve exercise endurance, supporting benefit in managing episodes of breathlessness and providing prophylactic treatment for exertional dyspnoea.

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Section: Introductionmentioning

confidence: 99%

“…16 Additionally, this systematic review did not include newly published RCTs with higher study quality and larger sample sizes than previous studies. 20 –24 Furthermore, the effectiveness of opioids in treating dyspnoea of COPD varies depending on factors such as different doses, types and courses of treatment. 13…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

Liu,

Xiao,

et al. 2023

Palliat Med

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“…The management of COPD presents a complex challenge, particularly in the advanced stages where symptom burden and quality of life become critical considerations. Among the various therapeutic options, the role of opioids in palliative care for COPD has been a subject of ongoing debate and investigation [ 3 ]. As the prevalence of COPD continues to rise globally, there is a need for effective interventions to alleviate symptoms, especially dyspnea.…”

Section: Introductionmentioning

confidence: 99%

Opioids in Treatment of Refractory Dyspnea in Chronic Obstructive Pulmonary Disease: Yes, No or Maybe

Rajnoveanu,

Harangus,

Todea

et al. 2024

JPM

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Chronic Obstructive Pulmonary Disease (COPD) is a complex condition with significant impact on prognosis, especially in advanced stages where symptom burden becomes critical. Breathlessness affects patients’ quality of life, and despite various therapeutic strategies, the role of opioids in palliative care for COPD remains under investigation. The acceptance of a therapeutic trial of different types of opioids is increasing not only in end-of-life situations but also for stable COPD patients experiencing intolerable refractory breathlessness despite optimal conventional therapy. Recent clinical trials have raised questions about the overall clinical benefit of opioids in addressing breathlessness in COPD, prompting the need to clarify inconsistencies and identify specific subgroups that may benefit from opioid therapy. In the clinical setting, it is crucial to understand the attributes of patients who exhibit positive responses to opioids and what type of opioids could have a positive impact. This research paper aims to offer an update of the most recent evidence of opioid treatment in managing breathlessness among individuals with COPD with a head-to-head evaluation of the supporting and opposing proof in the medical literature.

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A critical review of the respiratory benefits and harms of orally administered opioids for dyspnea management in COPD

Vozoris

2021

Expert Review of Respiratory Medicine

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Opioids for Dyspnea in Chronic Obstructive Pulmonary Disease: Short on the Details

Cited by 3 publications

References 7 publications

Effectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

Effectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials

Opioids in Treatment of Refractory Dyspnea in Chronic Obstructive Pulmonary Disease: Yes, No or Maybe

A critical review of the respiratory benefits and harms of orally administered opioids for dyspnea management in COPD

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