Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Cindy A. Verberkt*, Marieke H. J. van den Beuken-van Everdingen, Jos M. G. A. Schols, Sushma Datla, Carmen D. Dirksen, Miriam J. Johnson, Sander M. J. van Kuijk, Emiel F. M. Wouters, Daisy J. A. Janssen

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

43 Citations (Web of Science)

Abstract

Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.

PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible.

We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08-0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).

We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.

Original languageEnglish
Article number1701153
Number of pages18
JournalEuropean Respiratory Journal
Volume50
Issue number5
DOIs
Publication statusPublished - 1 Nov 2017

Keywords

  • OBSTRUCTIVE PULMONARY-DISEASE
  • CHRONIC HEART-FAILURE
  • TRANSMUCOSAL FENTANYL CITRATE
  • SUSTAINED-RELEASE MORPHINE
  • PALLIATIVE CARE PATIENTS
  • RANDOMIZED CONTROLLED-TRIAL
  • TERMINALLY-ILL PATIENTS
  • LOW-DOSE DIAMORPHINE
  • CANCER-PATIENTS
  • NEBULIZED MORPHINE

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