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Original research
Chronic breathlessness in advanced cardiorespiratory disease: patient perceptions of opioid use
  1. Thomas Moran1,
  2. Dominica Zentner2,3,
  3. James Wong2,3,
  4. Jennifer Philip3,4 and
  5. Natasha Smallwood3,5
  1. 1 The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. 2 Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. 3 The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
  4. 4 Palliative Care Service, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  5. 5 Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Natasha Smallwood, Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia; natasha.smallwood{at}mh.org.au

Abstract

Objective Low-dose oral opioids may improve severe chronic breathlessness in advanced cardiorespiratory diseases. Prescription of opioids for breathlessness occurs infrequently however, with little known about patients’ attitudes towards their use in this setting. The aim of this qualitative study was to explore patients’ perceptions regarding opioids for the management of severe chronic breathlessness in people with advanced cardiorespiratory disease.

Methods A cross-sectional, qualitative study was undertaken using outpatients with severe chronic breathlessness due to either severe chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). Indepth, semistructured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data.

Results Twenty-four participants were purposively sampled from three different groups: opioid-naïve patients with COPD (n=7), opioid-naïve patients with CHF (n=7) and patients with COPD using opioids currently or previously for severe chronic breathlessness (n=10). Four major themes were shared by both the opioid-naïve and opioid-experienced cohorts: (1) stigmatised attitudes and beliefs regarding opioids, (2) limited knowledge and information-seeking behaviour regarding opioids, (3) the impact of the relationships with health professionals and continuity of care, and (4) the significance of past experiences with opioids. An additional theme that was unique to the opioid-experienced cohort was (5) the perception of benefit and improved quality of life.

Conclusion Lack of knowledge regarding the role of opioids in managing severe chronic breathlessness, opioid misinformation and social stigmas are major barriers to opioid therapy that may be overcome by accurate information from trusted health professionals.

  • chronic obstructive pulmonary disease
  • dyspnoea
  • heart failure
  • chronic conditions
  • quality of life
  • respiratory conditions

Data availability statement

Data are available upon reasonable request. Due to the sensitive nature of the indepth interviews in this research project, complete transcripts can be made available only upon reasonable request in order to protect potentially identifiable data of participants. Request may be made to the corresponding author via email.

https://doi.org/10.1136/bmjspcare-2020-002853

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    Data availability statement

    Data are available upon reasonable request. Due to the sensitive nature of the indepth interviews in this research project, complete transcripts can be made available only upon reasonable request in order to protect potentially identifiable data of participants. Request may be made to the corresponding author via email.

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    Footnotes

    • Twitter @mrtommymoran

    • Contributors NS and TM share guarantorship of this study. TM: conception or design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published. DZ: conception or design of the work, data collection, data analysis and interpretation, critical revision of the article, final approval of the version to be published. JW: data collection, final approval of the version to be published. JP: conception or design of the work, final approval of the version to be published. NS: conception or design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.