Can we predict which patients with refractory dyspnea will respond to opioids?

Published

Journal Article

INTRODUCTION: Dyspnea is frequently encountered in end-stage diseases even when reversible issues are addressed. Which clinical factors best define patient subpopulations that will most predictably benefit from opioids in this clinical setting? METHODS: Thirty-eight patients with refractory dyspnea were randomized to an 8-day crossover trial of 4 days of 20 mg sustained release morphine or placebo, switching arms on day 5 (Clinical Trial Registry Number: ACTRN012607000075482). Dyspnea was measured on a 100-mm visual analogue scale (VAS). Day 4 and day 8 morning and evening VAS scores were the primary outcome. Correlation between baseline dyspnea and response to opioids was explored; potentially important clinical predictors tested with two-sided Student's t test. RESULTS: In this exploratory study, no relationship could be defined between baseline dyspnea and response to opioids (Spearman correlation 0.03, p = 0.88). The study was not powered to define other predictors, but younger age, better functional status, and significant cardiac findings on entry to the study deserve further prospective evaluation in a larger cohort. DISCUSSION: Phase 4 pharmaco-vigilance trials are needed in palliative care to define people who are most likely to experience a net benefit from treatment such as opioids for refractory dyspnea.

Full Text

Cited Authors

  • Currow, DC; Plummer, J; Frith, P; Abernethy, AP

Published Date

  • October 2007

Published In

Volume / Issue

  • 10 / 5

Start / End Page

  • 1031 - 1036

PubMed ID

  • 17985956

Pubmed Central ID

  • 17985956

Electronic International Standard Serial Number (EISSN)

  • 1557-7740

International Standard Serial Number (ISSN)

  • 1096-6218

Digital Object Identifier (DOI)

  • 10.1089/jpm.2007.9912

Language

  • eng