We thank M. Ekström and co-workers for their interest in our manuscript  and for their contributions to the important topic of opioid drug use in chronic obstructive pulmonary disease (COPD). M. Ekström and co-workers stress the efficacy of selective use of opioids for refractory breathlessness in COPD. We acknowledged in our manuscript  that several clinical studies demonstrate that opioids are efficacious in selected COPD patients for relieving refractory breathlessness. However, we have previously outlined reasons why such trials of drug efficacy have limited ability to comprehensively evaluate for possible drug harms [1–3]. Furthermore, chronic musculoskeletal pain, and not respiratory symptoms, is likely the more common reason why individuals with COPD use opioid drugs [3, 4]. Indeed, M. Ekström and co-workers recently published data showing that 97% of opioid prescriptions among Swedes with advanced COPD were for pain . Several Cochrane reviews have suggested there is insufficient evidence to support the use of opioids for chronic musculoskeletal pain [6–8].
The potential for respiratory-related harm needs to be considered when using opioid drugs in non-palliative COPD http://ow.ly/i5W03095MKV
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received December 23, 2016.
- Accepted December 23, 2016.
- Copyright ©ERS 2017