Background Cystic fibrosis (CF) remains an incurable condition in respiratory medicine. One of the main symptoms is dyspnoea. CF is a multi-system disorder and treatment of pulmonary symptoms tends to focus on medication which can be nebulised therefore minimizing the systemic side effects. Traditionally in palliative medicine opioids are effective at relieving dyspnoea however nebulised opioid is not routinely recommended. In patients with CF who are at risk of gastrointestinal complications such a distal intestinal obstruction syndrome(DIOS), administration of nebulised opioids has been sporadically reported to improve dyspnoea and minimize the risk of constipation.

The aim of this systematic review was to examine the role of nebulised opioids in improving dyspnoea in patients with CF.

Methods Medline (1946–2018) and Embase (1974–2018) were searched. Eligible studies met the following criteria: patients with CF, patients>13 years of age

Results 70 studies were eligible. Three studies fulfilled the criteria for review. The three studies described different case reports of nebulised opioid in patients with CF. The ages ranged from 13 years to 48 years. All patients had end stage respiratory failure due to CF. Two patients received nebulised morphine and one patient received nebulised fentanyl. Improvements in dyspnoea were graded according to improvement in BORG score. An adverse effect of a headache was noted in one patient occurring 48 hours after nebulised morphine had commenced.

Conclusion Nebulised morphine and fentanyl have been used to improve dyspnoea due to CF in a very limited number of patients, therefore no conclusion advocating the use of nebulised opioids can be made. Further research in the form of randomised controlled trials is needed to improve the evidence base of symptom control in patients with CF. This research must also focus on adverse gastrointestinal side effects such as constipation increasing the risk of DIOS.