Opioids for the palliation of breathlessness in advanced disease and terminal illness.
Abstract
Background
Breathlessness is a common symptom in people with advanced disease. The most effective treatments are aimed at treating the underlying cause of the breathlessness but this may not be possible and symptomatic treatment is often necessary. Strategies for the symptomatic treatment of breathlessness have never been systematically evaluated. Opioids are commonly used to treat breathlessness: the mechanisms underlying their effectiveness are not completely clear and there have been few good‐sized trials in this area.
Objectives
To determine the effectiveness of opioid drugs given by any route in relieving the symptom of breathlessness in patients who are being treated palliatively.
Search methods
An electronic search was carried out of Medline, Embase, CINAHL, T he Cochrane L ibrary, Dissertation Abstracts, Cancercd and SIGLE. Review articles and reference lists of retrieved articles were hand searched. Date of most recent search: May 1999.
Selection criteria
Randomised double‐blind, controlled trials comparing the use of any opioid drug against placebo for the relief of breathlessness were included. Patients with any illness suffering from breathlessness were included and the intervention was any opioid, given by any route, in any dose.
Data collection and analysis
Studies identified by the search were imported into a reference manager database. The full texts of the relevant studies were retrieved and data were independently extracted by two review authors. Studies were quality scored according to the Oxford Quality scale. The primary outcome measure used was breathlessness and the secondary outcome measure was exercise tolerance. Studies were divided into non‐nebulised and nebulised and were analysed both separately and together. A qualitative analysis was carried out of adverse effects of opioids. Where appropriate, meta‐analysis was carried out.
Main results
Eighteen studies were identified of which nine involved the non‐nebulised route of administration and nine the nebulised route. A small but statistically significant positive effect of opioids was seen on breathlessness in the analysis of studies using non‐nebulised opioids. There was no statistically significant positive effect seen for exercise tolerance in either group of studies or for breathlessness in the studies using nebulised opioids.
Authors' conclusions
There is evidence to support the use of oral or parenteral opioids to palliate breathlessness although numbers of patients involved in the studies were small. No evidence was found to support the use of nebulised opioids. Further research with larger numbers of patients, using standardised protocols and with quality of life measures is needed.
Plain language summary
Opioids (chemical substance) for palliation for breathlessness in terminal illness
There is evidence in favour of using oral or injectable opioid drugs for the palliative treatment of breathlessness. Breathlessness is common in people with advanced disease and opioid drugs are often used to treat it. A review to assess the effectiveness of opioids in these patients found a small but statistically significant positive effect when opioids were administered orally or subcutaneously. However, there was no evidence to support the use of nebulised (inhaled) opioids for the treatment of breathlessness. There was a lack of consistent evidence in support of the use of opioids administered via any route to improve exercise tolerance.
