Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness

Updates in palliative care – recent advancements in the pharmacological management of symptoms

“…Central processing modulation of breathlessness (similar to modulation of pain) and binding to peripheral opioid receptors within bronchioles and alveolar walls both occur. 10 Recent neuroimaging research suggests opioids may also alter conditioned anticipatory brain responses to breathlessness.…”

“…10 Although this likely decreases higher cortical awareness of dyspnoea (through 'corollary discharge'), 12 physicians sometimes fear this may also lead to respiratory depression. Lowdose opioids have, however, been shown to be safe even in very severe COPD 9 and no cases of respiratory depression were reported in studies using low-dose (≤30 mg oral morphine equivalent/day) sustained release opioids for treatment of refractory breathlessness.…”

“…10 Subsequently, Ekstrom et al performed a re-analysis to statistically adjust for matched data within the many crossover trials (92% of trials). The authors concluded that evidence supporting low-dose systemic opioids is moderate, and that they decrease breathlessness overall by an average of 0.8 points on a 0-10 scale.…”

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep

“…These findings add to the limited but much needed evidence regarding safety and efficacy of opioids in this setting. 105 …”

Application of palliative ventilation: potential and clinical evidence in palliative care

“…Opioids may help to relief the burden due to dyspnea when acute respiratory distress is not yet present, although there is some low-quality evidence showing benefits with the use of oral or parenteral opioids to palliate breathlessness [9]. While low flow oxygen has been shown to be efficacious for dyspnea only in hypoxemic patients [10].…”