O10.1 Opioids

Regular low dose oral morphine may be considered for treating breathlessness in patients with severe COPD that persists despite optimal medical management. A 2015 systematic review and meta-analysis comparing opioids with placebo in 16 studies (271 participants, of whom 95% had COPD) found small short-term benefits in dyspnoea with minimal adverse effects, but no effects on exercise capacity and unclear effects on quality of life (Ekstrom 2015) [evidence level I]. Adverse effects include constipation, nausea and light-headedness and in the reviewed studies no hypoventilation, respiratory depression or treatment-related hospitalisations or death were observed. Nonetheless, opioids should be used with care in COPD. There is little evidence to support nebulised opioids in the treatment of breathlessness (Jennings 2002). The opioid dose required for symptom control should be established by titration, starting at a low dose and increasing until efficacy is achieved. There is little comprehensive evidence to guide clinicians on the use of opioids in COPD symptom control.