Clemens, K.E., & Klaschik, E. (2007). Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. Journal of Pain and Symptom Management, 33(4), 473–481.

DOI Link

Study Purpose

The objective of this study was

  • To assess whether, and/or in which way, symptomatic treatment of dyspnea with opioids is associated with respiratory depression
  • To verify whether nasal water insufflations and opioid administration respectively lead to decrease in dyspnea.

Intervention Characteristics/Basic Study Process

One opioid dose of morphine (mean dose 9.4 mg [SD = 8.8 mg]) or hydromorphone (morphine equivalent dose of 10.8 mg [SD = 3.8 mg])

Sample Characteristics

The sample was comprised of 11 patients with dyspnea (5 severe, 4 moderate, and 2 mild), 8 patients with lung cancer, 2 patients with breast cancer, and 1 patient with acute lymphoblastic leukemia. None of the patients had a history of chronic obstructive pulmonary disease.Two patients were pretreated with opioids for pain control.

Setting

The study was conducted on an inpatient palliative care unit.

Study Design

The study was a prospective, nonrandomized, uncontrolled trial.

Measurement Instruments/Methods

The following were measured at baseline on room air after 30 minutes of nasal oxygen at 2 L per minute and at 30, 60, 90, and 120 minutes after opioid dose.
  • Numerical rating scale (NRS) 0-10 severity of dyspnea
  • NRS 0-10 anxiety
  • Arterial pressure of carbon dioxide (pCO2)
  • Oxygen saturation %
  • Pulse rate

Results

After opioid administration

  • No significant change in oxygen saturation (pCO2) or pulse rate was observed.
  • A significant (p = 0.003) decrease in respirations from 41 (SD = 4.7) to 26.5 (SD = 5.3) was noted.
  • A significant decrease in dyspnea score (p = 0.003) at rest from 5.4 (SD = 2.5) on admission to study to 0.9 (SD = 0.8) at 120 minutes and dyspnea on exertion from 7.5 (SD = 2.7) to 2.9 (SD = 1.5) at 120 minutes was noted.
  • A significant decrease in anxiety also was observed (p = 0.003).

Patients’ ratings showed no significant decrease in dyspnea intensity with nasal oxygen.

Conclusions

Decreased respiratory rate and decreased dyspnea scores with opioid dose were evident.

Limitations

  • Respiratory depression with therapeutic doses of strong opioids was excluded.
  • Study limitations are small sample size and uncontrolled, nonrandomized design.
  • A possible contamination is that patients also were offered psychological, spiritual, and nonpharmacologic therapy (e.g., breathing therapy, relaxation exercise) as part of routine palliative care.