Opioids for the palliation of breathlessness in advanced disease and terminal illness

Fentanyl for the Relief of Refractory Breathlessness: A Systematic Review

“…The most frequent route of administration was nebulized fentanyl. This is surprising because the Cochrane review by Jennings et al 9 reported no significant effects of nebulized opioids for the relief of breathlessness, whereas the findings for orally or parentally administered opioids were favorable. However, self-made nebulized and intranasal applications were the only possibilities for noninvasive administration of fentanyl until a few years ago; licensed applications (e.g., buccal or sublingual) were not yet available.…”

“…In most cases, morphine is administered orally or parenterally. 9,10 Two different patterns of breathlessness have been identified: chronic or continuous breathlessness (breathlessness all the time) and episodes of breathlessness (acute, incident, breakthrough breathlessness). 8,11 Episodes of breathlessness are defined as a ''clinically significant aggravation of dyspnoea in patients with continuous dyspnoea or occurring intermittently'' and characterized by a sudden increase of breathlessness intensity with a short duration.…”

Enkephalin, its precursor, processing enzymes, and receptor as part of a local opioid network throughout the respiratory system of lung cancer patients

“…In other studies, opioid peptides inhibited parasympathetically stimulated bronchial smooth muscle contractions that were antagonized by local naloxone [5]. Several previous clinical trials reported that some patients might benefit from inhalation of nebulized opioids, whereas others do not [7]. However, particularly terminally ill patients with dyspnea and shortness of breath-for example, due to lung cancer or end-stage cystic fibrosis-seem to have significant relief [8,9].…”

Was sollte der Pneumologe über Palliativmedizin wissen?

“…In strukturierten Interviews mit Patienten und ihren Behandelnden in zwei spezialisierten Zentren in London zeigte sich eine hohe Unzufriedenheit der Patienten bezüglich der Symptomlast und deren Einfluss auf das täg-liche Leben. Die Behandelnden neigten dazu, diese Beschwerden sowie die psy- [20].…”