TY - JOUR
T1 - Respiratory adverse effects of opioids for breathlessness
T2 - a systematic review and meta-analysis
AU - Verberkt, Cindy A.
AU - van den Beuken-van Everdingen, Marieke H. J.
AU - Schols, Jos M. G. A.
AU - Datla, Sushma
AU - Dirksen, Carmen D.
AU - Johnson, Miriam J.
AU - van Kuijk, Sander M. J.
AU - Wouters, Emiel F. M.
AU - Janssen, Daisy J. A.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - CHRONIC HEART-FAILURE
KW - TRANSMUCOSAL FENTANYL CITRATE
KW - SUSTAINED-RELEASE MORPHINE
KW - PALLIATIVE CARE PATIENTS
KW - RANDOMIZED CONTROLLED-TRIAL
KW - TERMINALLY-ILL PATIENTS
KW - LOW-DOSE DIAMORPHINE
KW - CANCER-PATIENTS
KW - NEBULIZED MORPHINE
U2 - 10.1183/13993003.01153-2017
DO - 10.1183/13993003.01153-2017
M3 - (Systematic) Review article
C2 - 29167300
SN - 0903-1936
VL - 50
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 5
M1 - 1701153
ER -