Opioid Prescription Method for Breathlessness Due to Non-Cancer Chronic Respiratory Diseases: A Systematic Review

Yasuhiro Yamaguchi, K.M. Saif-Ur-Rahman, Motoko Nomura, Hiromitsu Ohta, Yoshihisa Hirakawa, Takashi Yamanaka, Satoshi Hirahara and Hisayuki Miura
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Yasuhiro Yamaguchi: Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
K.M. Saif-Ur-Rahman: Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
Motoko Nomura: Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
Hiromitsu Ohta: Department of Pulmonary Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
Yoshihisa Hirakawa: Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
Takashi Yamanaka: Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Satoshi Hirahara: Tokyo Fureai Medical Co-op Research & Education Center, Tokyo 114-0004, Japan
Hisayuki Miura: Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan

IJERPH, 2022, vol. 19, issue 8, 1-16

Abstract: A previous pooled analysis demonstrated significant relief of breathlessness following opioid administration in patients with chronic obstructive pulmonary disease. However, in clinical practice, it is important to know the characteristics of patients responding to opioids, the best prescription methods, and the evaluation measures that can sufficiently reflect these effects. Thus, we performed a systematic review of systemic opioids for non-cancer chronic respiratory diseases. Fifteen randomized controlled studies (RCTs), four non-randomized studies, two observational studies, and five retrospective studies were included. Recent RCTs suggested that regular oral opioid use would decrease the worst breathlessness in patients with a modified Medical Research Council score ≥ 3 by a degree of 1.0 or less on a scale of 1–10. Ergometer or treadmill tests indicated mostly consistent significant acute effects of morphine or codeine. In two non-randomized studies, about 60% of patients responded to opioids and showed definite improvement in symptoms and quality of life. Furthermore, titration of opioids in these studies suggested that a major proportion of these responders had benefits after administration of approximately 10 mg/day of morphine. However, more studies are needed to clarify the prescription method to reduce withdrawal due to adverse effects, which would lead to significant improvements in overall well-being.

Keywords: breathlessness; chronic obstructive pulmonary disease; dyspnea; interstitial lung disease; morphine; opioid; palliative care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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