Coyne, P. J., Viswanathan, R., & Smith, T. J. (2002). Nebulized fentanyl citrate improves patients’ perception of breathing, respiratory rate, and oxygen saturation in dyspnea. Journal of Pain and Symptom Management, 23, 157–160.

To test the theory:  \"Inhaled opioids usually are ineffective with report of respiratory depression; however, fentanyl may be more readily absorbed with less bronchospasm and thus relieve dyspnea.\"

Patients were given 25 mcg of fentanyl with 2 mL of saline via a nebulizer.

• The sample was comprised of 35 patients (20 women, 15 men) with terminal cancer who reported shortness of breath. 
• Average age was 56 years.
• Thirty-four patients were on oxygen. 

• Inpatient
• Oncology unit

The study used a convenience sample, uncontrolled design.

• Patients’ perceptions of breathing (same, worse, or improved) were measured one hour after treatment.
• Respiratory rate and oxygen saturation were measured at baseline and at 5 and 60 minutes following the intervention.

• Twenty-six of 32 patients (81%) reported improvement in breathing.
• Three of 32 (9%) patients were unsure of their results.
• Three of 32 (9%) patients reported no improvement.
• Mean oxygen saturation significantly improved from 94.6% to 96.8% (p < 0.001) at five minutes and to 96.7% (p < 0.006) at 60 minutes.
• Mean respiratory rate significantly decreased from 28.4 at baseline to 25.8 at five minutes (p < 0.03) and to 24.1 at 60 minutes (p < 0.02).

Fentanyl improved all three measures and may offer substantial relief of dyspnea. No significant side effects were reported.

• The study was not randomized and needs confirmation in a randomized, controlled trial.
• The impact of the carrier saline is unknown.
• Also unknown is the cause of attrition of three patients and whether patients were opioid tolerant or naïve.

Clinical questions about repeated dosing and method of administration (mask or mouthpiece) remain.