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Morphine for chronic breathlessness in COPD: improvement predictors—cross-sectional study
  1. Cornelia A Verberkt1,
  2. Marieke H J van den Beuken-Everdingen2,
  3. Jos M G A Schols1,3,
  4. Emiel F M Wouters4,5,6 and
  5. Daisy J A Janssen1,5
  1. 1Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  2. 2Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
  3. 3Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
  5. 5Department of Research & Development, Ciro, Horn, The Netherlands
  6. 6Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
  1. Correspondence to Dr Daisy J A Janssen, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; daisyjanssen{at}ciro-horn.nl

Abstract

Objective Morphine is used as palliative treatment of chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD). Part of the patients does not experience a clinically meaningful improvement of breathlessness and it is unclear which characteristics are related to a clinically meaningful improvement of breathlessness after morphine. Therefore, this study assessed whether sensory breathlessness description, demographic and clinical characteristics are related with this improvement.

Methods Cross-sectional secondary analysis of the intervention arm of a randomised controlled trial. 45 patients with COPD and moderate-to-very severe chronic breathlessness despite optimal treatment received 20–30 mg oral sustained-release morphine daily for 4 weeks. Using binary logistic regression, the relationship between a clinically meaningful improvement in breathlessness (≥1 point on 0–10 numeric rating scale) and the baseline variables sensory breathlessness descriptors, age, breathlessness and body mass index (BMI) was assessed.

Results Twenty-one participants (42%) showed a clinically meaningful improvement. Baseline breathlessness (OR 1.51, 95% CI 1.04 to 2.21, p=0.03) and BMI (OR 1.13, 95% 1.02–1.28, p=0.02) were significant associated to a clinically meaningful improvement of breathlessness, while age and sensory breathlessness descriptors were not.

Conclusions Worse baseline breathlessness and higher BMI are associated to a clinically meaningful improvement of breathlessness in patients using 20–30 mg oral sustained-release morphine. Opioid treatment should be considered in patients with COPD with severe breathlessness, taking into account the patient’s BMI.

  • Chronic obstructive pulmonary disease
  • Dyspnoea
  • Drug administration

http://dx.doi.org/10.1136/spcare-2022-003693

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    Footnotes

    • Twitter @cindyverberkt

    • Contributors CAV and DJAJ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: CAV, MHJvdB-E, JMGAS, EFMW, DJAJ. Acquisition, analysis, or interpretation of data: CAV, MHJvdB-E, DJAJ. Drafting of the manuscript: CAV, MHJvdB-E, DJAJ. Critical revision of the manuscript for important intellectual content: CAV, MHJvdB-E, JMGAS, EFMW, DJAJ. Statistical analysis: CAV. Obtained funding: MHJvdB-E, DJAJ. Administrative, technical, or material support: CAV. Supervision: MHJvdB-E, JMGAS, EFMW, DJAJ.

    • Funding This work was supported by The Netherlands Organization for Health Research and Development (ZonMW) [grant number 836 031 012].

    • Disclaimer The funding source had no role in the design of the study, conduct of the research, preparation of the article, and the decision to submit the article for publication.

    • Competing interests MHJvdB-E reports personal fees from Kyowa Kirin and MSD, outside the submitted work. DJAJ reports grants from ZonMw, the Hague, the Netherlands, during the conduct of the study; personal fees from Boehringer Ingelheim, Novartis, and AstraZeneca, outside the submitted work.

    • 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.