Disabling dyspnoea in patients with advanced disease: lack of effect of nebulized morphine

Abstract

The purpose of this placebo-controlled, double-blind, randomized study was to assess the effect of nebulized morphine on dyspnoea perceived at rest by patients with advanced disease.Seventeen hospital in-patients with disabling dyspnoea received isotonic saline or morphine via nebulization for 10 min through a mouthpiece, combined with oxygen via nasal prongs. On four consecutive days, they were given one of the four following treatments in random order: saline with 2 L·min -1 oxygen; 10 mg morphine with 2 L·min -1 oxygen; 20 mg morphine with 2 L·min -1 oxygen; and 10 mg morphine without oxygen (prongs fixed, no flow). Dyspnoea was assessed on a bipolar visual analogue scale (VAS) (-100% much more short of breath, +100% much less short of breath), and arterial oxygen saturation (Sa,O 2 ) and respiratory frequency (f R) were recorded at the end of nebulization and 10 min later.In 14 subjects who completed the study, mean VAS ratings 10 min after the end of nebulization ranged +30 to +43%, with no significant difference between the four study days (VAS 20 mg morphine minus VAS saline, 95% confidence interval (95% CI) -6 to +8%). Sa,O 2 significantly increased on the 3 days with supplemental oxygen, and remained stable on the zero flow day. Respiratory frequency significantly decreased on the 4 days, with a trend to correlation between VAS rating and parallel change in respiratory frequency (Spearman's rank correlation coefficient (r s )=-0.46; p=0.09).We conclude that the subjects benefited from saline or morphine via a placebo effect and/or a nonspecific effect, and that nebulized morphine had no specific effect on dyspnoea.

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

“…A review of 18 randomized studies comparing aerosolized and intravenous narcotics demonstrated comparable effectiveness, with neither superior. 113 This is in contrast to a randomized crossover study by Noseda et al 114 showing that neither 10 nor 20 mg of nebulized morphine was any different than a saline placebo as judged by patient dyspnea scales. A similar study using 20 and 40 mg of nebulized morphine produced no improvement in perceived dyspnea or the 6-min walk test relative to placebo.…”

The management of dyspnea in cancer patients: a systematic review

“…Fifteen of those trials [4,7,10,11,15,17,21,23,28,30,32,36,39,47] were also eligible for our systematic review. The literature sources, abbreviated search strategy, and selection criteria were provided.…”

“…Only five trials reported using a washout period [14,24,31,39,40]. Five trials reported a calculated sample size [2,8,32,36,39], and three met the target [32,36,39]. Two trials received support from pharmaceutical companies [1,46].…”

“…Six trials included only cancer patients [2,7,8,11,33,35], and three included some cancer patients [1,36,37]. The randomized crossover design was the most common.…”

Eine “Epidemiologie” zum Stellenwert von oral appliziertem Morphium als Therapieform des schwergradigen Lungenemphysems vom Pink-Puffer-Typ

“…Studien zur Morphiumtherapie bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) und Lungenemphysem ergaben ein kontroverses Bild. Neben nachgewiesener Effektivität [7,9,10,17,21,23] blieben andere Studien ohne Effektivitätsnachweis [1,4,6,8,[10][11][12]16].…”