There isn’t enough data to say whether opioids like morphine, which are sometimes used to treat patients, are effective for treating severe chronic dyspnea. In a randomised Phase 3 study, researchers from Sweden and Australia discovered that morphine does not alleviate the worst cases of dyspnea.
Long-term breathing problems are a frequent source of unrelenting suffering that frequently happens with advanced serious illnesses and near the end of life. Physical exertion is frequently difficult for chronically ill people who have severe, long-term dyspnea as a result of COPD’s lungs and airways damage.
“Many people struggle daily with breathing issues. “Although it is disappointing that there is no better option, given the outcomes we have observed, we are unable to generally advise giving morphine to those who experience chronic breathlessness,” says Magnus Ekström, chief physician in pulmonary medicine at Blekinge Hospital and a researcher in palliative medicine and pulmonary medicine at Lund University in Sweden.
The study involved 156 individuals with chronic obstructive pulmonary disease (COPD) who had severe long-term dyspnea for a period of three weeks apiece. The patients were divided into three groups at random during the first week, with one group receiving a placebo and the other two receiving low-dose, once-daily morphine treatment (8 or 16 mg).
Participants were randomized to receive either an additional 8 milligrams of morphine or a placebo during the course of the following two weeks. This was done to examine the treatment’s effectiveness and the possibility of negative effects from a higher morphine dosage. The “double-blind” nature of the treatment meant that neither the participants nor the healthcare professionals knew which treatment each group was receiving.
According to David Currow, a palliative medicine physician at the University of Wollongong in Australia, whose team worked on the study as part of a national program to improve symptom control of people with advanced, life-limiting illnesses, “Given the prevalence of long-term breathlessness across the world, it is crucial that we find ways to safely and predictably reduce the suffering that this causes people, often for years.”
The groups’ ratings of their experiences with shortness of breath were then compared by the researchers. The participants’ physical activity during the study was also assessed by the researchers using motion sensors.
“Some may have anticipated that the trial would demonstrate that frequent, low-dose morphine treatment may enable individuals to engage in greater physical activity.” Unfortunately, we did not see this across all subjects. “The participants’ severe cases of breathlessness showed no signs of improvement,” Magnus Ekström says.
Ekström contends that groups of people who have persistent, activity-limiting shortness of breath shouldn’t be treated with regular, low doses of morphine in the healthcare system.
“The study should not be taken as proving that morphine does not relieve severe shortness of breath at rest or in patients receiving palliative care near the end of their lives.” That was not looked into in the study. Most of the time, our patients did not experience breathing difficulties when at rest. “Clinical evidence suggests that morphine treatment can be helpful in crisis situations and at the end of life,” Magnus Ekström states.
The next phase will be to more thoroughly examine if any particular groups respond to morphine more favorably and which groups are more likely to experience negative side effects.
