Williamson, A.; Restrick, L.; Potter, C.; Purcell, S.; Roberts, S.; Coleman, B.; Stern, M.
December 2011
Thorax;Dec2011 Supplement, pA174
Academic Journal
Introduction Breathlessness is the most common and frightening symptom in Chronic Obstructive Pulmonary Disease (COPD). Short-acting morphine (Oramorph) has traditionally been used to treat breathlessness in palliative care. Although used in COPD (Simon et al, 2010), there is no consensus/guidelines for prescribing and patients stigmatise morphine, associating it with dying or addiction. In this study, we assessed current prescribing practice, patient use and safety of Oramorph, to inform local prescribing guidelines and patient information. Method Case notes of patients who were prescribed Oramorph for breathlessness while having multidisciplinary COPD care between 2004 and 2011 were reviewed. The following were documented: patient demographics, disease severity (FEV1, MRC dyspnoea score, nebulisers, long term oxygen therapy (LTOT), domiciliary Non-Invasive Ventilation (NIV), social/healthcare support and palliative care referrals; Oramorph starting dosage, dosage range, increase in dosage, patient choice to continue, duration of and use of morphine sulphate slow release tablet (MST). Results 28 COPD patients prescribed Oramorph for breathlessness were identified (14 M), median (range) age 70 (52-83) years FEV1 (mean±SD) 0.58±0.22, MRC dyspnoea score 4.6±0.49. 19/28 (68%) were on LTOT, 28/28 (100%) on nebulisers, 5/28 (17%) on domiciliary NIV, two current smokers, 10/28 (36%) lived alone, 27/28 (96%) had professional healthcare domiciliary visits, 8/28 (29%) had palliative care input. Starting, incremental and current dosing of Oramorph are shown in the Abstract P262 table 1. 25/28 (89%) patients chose to stay on Oramorph once started. Median (range) duration on Oramorph was 8 months (45 days-7.5 years). MST was added for breathlessness in three patients. 13/28 (46%) patients died; all were MRC 5 and starting Oramorph was not felt to be a contributing factor by the clinical team. Time to death after starting Oramorph was median (range) 7 months (68 days-2.6 years). Oramorph prescribing in COPD increased year-on-year (one patient in 2004 to 12 in 2010). Conclusion Oramorph prescribed by a respiratory team for breathlessness is safe in this group of patients. This study indicates that its effect is sustained despite low dosages with little requirement for incremental dosing over time. Guidelines for prescribing and patient information will be critical to ensure that patients are not denied this useful treatment of breathlessness.


Related Articles

  • ASSESSING THE EDUCATIONAL IMPACT OF PULMONARY REHABILITATION IN NON-COPD PATIENTS USING THE LUNG INFORMATION NEEDS QUESTIONNAIRE. Fowler, R. P.; Ardelean, D.; Ingram, K. I.; Clark, A. L.; Marns, P. L.; Kon, S. S. C.; Canavan, J. L.; Man, W. D.-C. // Thorax;Dec2011 Supplement, pA16 

    Background There is increasing evidence to suggest that pulmonary rehabilitation (PR) improves exercise capacity, health status and dyspnoea in non-COPD chronic respiratory disease patients. However it is not clear how to assess the education component of PR on these patients. The Lung...

  • Chronic obstructive pulmonary disease. Whittaker, C. // South African Family Practice;Jan/Feb2013, Vol. 55 Issue 1, p20 

    Chronic obstructive pulmonary disease affects millions of people, has a major impact on quality of life and has become an important cause of death worldwide. Over the past decade, a better understanding of COPD has been gained, while research into new therapies and treatment strategies has...

  • Short of Breath and Dying. Lowey, Susan E.; Powers, Bethel Ann; Ying Xue // Journal of Gerontological Nursing;Feb2013, Vol. 39 Issue 2, p43 

    The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that...

  • Trends in management and outcomes of COPD patients in primary care, 2000-2009: a retrospective cohort study. James, Gareth D.; Donaldson, Gavin C.; Wedzicha, Jadwiga A.; Nazareth, Irwin // Primary Care Respiratory Society UK;7/1/2014, p1 

    BACKGROUND: Since the introduction of the Quality and Outcomes framework, there has been some evidence of improvement in the management of chronic obstructive pulmonary disease (COPD) patients in the United Kingdom through increasing rates of smoking cessation advice and immunisations against...

  • Why Roflumilast Sometimes Fails COPD Patients.  // AARC Times;Jul2015, Vol. 39 Issue 7, p51 

    This article discusses findings of research from Georgia State University and the University of Rochester Medical Center about the drug roflumilast, referencing a study published in the journal "Proceedings of the National Academy of Sciences."

  • Low-dose opioids should be considered for symptom relief also in advanced chronic obstructive pulmonary disease (COPD). Ekström, Magnus; Bornefalk-Hermansson, Anna; Abernethy, Amy; Currow, David // Evidence Based Medicine;Feb2015, Vol. 20 Issue 1, p39 

    A letter to the editor is presented in response to the article "Benzodiazepines and opioids need to be prescribed with caution in advanced COPD" by N.T. Vozoris appeared in a 2014 issue of the periodical.

  • Response to Ekström et al regarding low-dose opioids in advanced chronic obstructive pulmonary disease. Vozoris, Nicholas T. // Evidence Based Medicine;Feb2015, Vol. 20 Issue 1, p40 

    A response from the author of the article "Benzodiazepines and opioids need to be prescribed with caution in advanced COPD" by N.T. Vozoris in the 2014 issue of the periodical is presented.

  • OUTCOMES OF PULMONARY REHABILITATION IN SEVERE ASTHMA. Agbetile, J.; Singh, S.; Bradding, P.; Pavord, I.; Green, R. // Thorax;Dec2011 Supplement, pA127 

    Objectives Structured physical training programmes are a key component of pulmonary rehabilitation (PR) and have consistently been shown to be of significant benefit to patients with COPD. It is unclear whether the application of similar principles provides similar health improvements in...

  • High-frequency chest wall oscillation in infective exacerbation of COPD: Is airway secretion clearance the cornerstone?  // Clinical Rehabilitation;Feb2014, Vol. 28 Issue 2, p206 

    The article explores the health implications for high-frequency chest wall oscillation in infective exacerbation of chronic pulmonary disease (COPD) in patient. It examines the effects of high frequency chest wall oscillation and its negative result with high-frequency chest walll oscillation in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics