Barnes, H., McDonald, J., Smallwood, N., & Manser, R. (2016). Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database of Systematic Reviews, 3, CD011008. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effectiveness of opioids in relieving the symptom of dyspnea in people with advanced disease

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, clinicaltrials.gov, WHO International Clinical Trials, Register of Controlled Trials 
 
INCLUSION CRITERIA: Parallel-group or crossover randomized, controlled trials comparing opioid to placebo or other treatment, participants with dyspnea despite treatment of reversible factors, any type of illness in advanced or palliative stage, opioid drug given by any route, adults
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 376
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias assessment and sample size, GRADE system of evidence classification. Eight were determined to have a low risk of bias, 18 were evaluated to have an unclear risk of bias, and the overall quality of evidence was reported to be low or very low.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 26 in review, 18 in meta-analysis 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 276 in meta-analysis
  • SAMPLE RANGE ACROSS STUDIES: 6–25
  • KEY SAMPLE CHARACTERISTICS: Cancer, chronic obstructive pulmonary disease (COPD), and heart disease were included.

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care
 
APPLICATIONS: Palliative care

Results

Based on change in dyspnea from baseline, no statistically significant difference existed with opioids across seven studies. This evidence showed high heterogeneity and low overall quality. A comparison of post-treatment dyspnea scores in 11 studies showed significant benefit with opioids (standard mean difference [SMD] = –0.28, 95% confidence interval [CI] [–0.5, –0.05], p = 0.02). No significant effects (two studies) existed for nebulized opioids. Six studies were of patients with cancer. A few studies evaluated breathlessness in terms of exercise tolerance only.

Conclusions

The findings show that oral opioids have some benefit for the relief of dyspnea and may have some benefit for short-term improvement in exercise capacity.

Limitations

  • Mostly low quality/high risk of bias studies
  • High heterogeneity
  • Low sample sizes
  • No subgroup quantitative analysis; differences for various patient subgroups were not analyzed.

Nursing Implications

Oral opioids are of benefit for reducing dyspnea. Nebulized opioids were not shown to be effective.

Legacy ID

6458