The effect of sustained-release morphine on breathlessness and quality of life in severe chronic obstructive pulmonary disease.

Morphine has been proposed as a treatment for breathlessness in patients with severe chronic obstructive pulmonary disease (COPD), but there is uncertainty as to whether or not it is effective. Orally administered sustained-release morphine was compared with placebo in a randomized, double-blind, crossover trial with two 6-wk treatment periods separated by a 2-wk washout period. The primary end point was quality of life measured using the Chronic Respiratory Disease Questionnaire (CRQ). Secondary end points included 6-min walk (6MW), distance, and breathlessness scores. Sixteen subjects with a mean age 70.7 yr, FEV1 of 0.6 L, and VC of 1.90 L were studied. There was no change in the total CRQ score with either treatment, but the score on the Mastery subscale was significantly worse with morphine (p = 0.02). The 6MW distance increased by 21 m from the beginning to the end of the placebo treatment period, but it decreased by 35 m with morphine (p = 0.04). There were no differences between treatments in breathlessness scored on daily diary cards or on the Dyspnea subscale of the CRQ. Almost all the subjects experienced adverse effects related to morphine. Sustained-release morphine was not a useful treatment for breathlessness in these patients with severe COPD.

[1]  D. O’Donnell,et al.  Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. , 1997, American journal of respiratory and critical care medicine.

[2]  J. Burdon,et al.  Effect of inhaled morphine on the development of breathlessness during exercise in patients with chronic lung disease. , 1996, Thorax.

[3]  J. W. Reed,et al.  Lack of effect of inhaled morphine on exercise-induced breathlessness in chronic obstructive pulmonary disease. , 1995, Thorax.

[4]  A. Rubinfeld,et al.  Chronic lung diseases and the perception of breathlessness: a clinical perspective. , 1994, The European respiratory journal.

[5]  R. Light,et al.  Effects of nebulized morphine sulfate on the exercise tolerance of the ventilatory limited COPD patient. , 1993, Chest.

[6]  N. Eiser,et al.  Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome. , 1991, The European respiratory journal.

[7]  E. Daviskas,et al.  Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. , 1989, Thorax.

[8]  S. Brown,et al.  Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. , 1989, The American review of respiratory disease.

[9]  G. Guyatt,et al.  A measure of quality of life for clinical trials in chronic lung disease. , 1987, Thorax.

[10]  H. D. Short,et al.  Bronchodilators in chronic air-flow limitation. Effects on airway function, exercise capacity, and quality of life. , 1987, The American review of respiratory disease.

[11]  E. Robin,et al.  Single-patient randomized clinical trial. Opiates for intractable dyspnea. , 1986, Chest.

[12]  G. Guyatt,et al.  Determining optimal therapy--randomized trials in individual patients. , 1986, The New England journal of medicine.

[13]  K. Killian,et al.  The objective measurement of breathlessness. , 1985, Chest.

[14]  R. Poe,et al.  Sensitivity, specificity, and predictive values of bronchoscopy in neoplasm metastatic to lung. , 1985, Chest.

[15]  A. Woodcock,et al.  Dihydrocodeine for breathlessness in "pink puffers". , 1983, British medical journal.

[16]  J. Marx,et al.  Breathlessness, alcohol, and opiates. , 1982, The New England journal of medicine.

[17]  A. Woodcock,et al.  Two-, six-, and 12-minute walking tests in respiratory disease. , 1982, British medical journal.

[18]  A. Woodcock,et al.  Effects of dihydrocodeine, alcohol, and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. , 1981, The New England journal of medicine.

[19]  T. V. Santiago,et al.  Effects of morphine on ventilatory response to exercise. , 1979, Journal of applied physiology: respiratory, environmental and exercise physiology.

[20]  R. Mccullough,et al.  Diminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. , 1975, The New England journal of medicine.

[21]  James E. Grizzle,et al.  Applications of multivariate analysis of variance to repeated measurements experiments. , 1966 .

[22]  J. Eckenhoff,et al.  The effects of narcotics and antagonists upon respiration and circulation in man. A review. , 1960, Clinical pharmacology and therapeutics.