Morphine for refractory breathlessness in advanced COPD


  • Heather Mason
  • Univadis Medical News
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A clinical trial conducted in patients with advanced chronic obstructive pulmonary disease (COPD) revealed that treatment with oral sustained-release morphine leads to improvement in disease-specific health status, according to an article published in JAMA Internal Medicine.

The analysis included 111 patients with moderate to very severe chronic breathlessness due to advanced COPD. Patients were randomised to either 10mg of regular, oral sustained-release morphine or placebo twice daily for four weeks (n=54) or placebo (n=57). Primary outcomes were COPD Assessment Test (CAT) and arterial partial pressure of carbon dioxide (PaCO2). The secondary outcome was breathlessness in the previous 24 hours (numeric rating scale).

The difference in CAT score was 2.18 points lower in the morphine group, PaCO2 was 1.19 mmHg higher in the morphine group, and breathlessness remained unchanged. Worst breathlessness improved in participants with modified Medical Research Council (mMRC) grades 3 to 4. No clinically relevant respiratory adverse effects occurred during the 4 weeks of treatment.

The authors conclude that regular, low-dose, oral sustained-release morphine for four weeks may have a positive effect on disease-specific health status in patients with moderate to very severe breathlessness and does not appear to lead to respiratory adverse effects.