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Physicians' attitudes to dyspnoea management in advanced chronic obstructive pulmonary disease (COPD)

Natasha Smallwood, David Currow, Sara Booth, Anna Spathis, Louis Irving, Jennifer Philip
European Respiratory Journal 2016 48: PA3748; DOI: 10.1183/13993003.congress-2016.PA3748
Natasha Smallwood
1Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VictoriaAustralia
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David Currow
2Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South AustraliaAustralia
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Sara Booth
3Department of Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Anna Spathis
3Department of Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Louis Irving
1Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VictoriaAustralia
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Jennifer Philip
4Centre for Palliative Care, St. Vincent's Hospital, Melbourne, VictoriaAustralia
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Abstract

Refractory breathlessness is common and undertreated in patients with advanced COPD. Dyspnoea management is often complex and may include opioids, however there is a perceived reluctance to utilise this treatment option.

Aims: To examine physicians' attitudes to dyspnoea management for COPD patients.

Methods: 2161 specialists and registrars in respiratory medicine (RM) (n=940) and palliative medicine (PM) (n=1221) in Australia, New Zealand and the UK were invited by email to complete an on-line, case-vignette based survey.

Results: Overall response rate 27% (n=574) and 446 completed dyspnoea management questions.

Respiratory Medicine n=183 (20%)Palliative Medicine n=263 (22%)
Male116 (63%)71 (27%)
Years in specialty practice (median)1312
Australia156 (85%)98 (37%)
New Zealand27 (15%)31 (12%)
UK0134 (51%)
Uses dyspnoea score routinely59 (32%)47 (18%)
Add dyspnoea medication127 (69%)239 (91%)
Recommended treatment for refractory dyspnoeaShort acting morphine 2.5-5mg 4-6hrly PRN74 (58%)197 (82%)
Long acting morphine 10-20mg/24hrs20 (16%)15 (6%)
Low dose benzodiazepine*15 (12%)6 (3%)
  • *e.g. Lorazepam 0.5mg BD or PRN

In a stable optimally managed COPD patient, 115 (63%) RM physicians and 220 (84%) PM physicians recommended adding a medication for refractory dyspnoea. A further 12 (7%) RM physicians and 19 (7%) PM physicians would consider this option.

In practice, only 65 (36%) RM physicians, compared with 213 (81%) PM physicians reported regularly prescribing opioids for COPD patients with refractory breathlessness.

Conclusions: While physicians recognised the role of opioids for refractory dyspnoea in COPD, this was not part of routine dyspnoea management for RM physicians.

  • COPD - management
  • Palliative care
  • Copyright ©the authors 2016
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Physicians' attitudes to dyspnoea management in advanced chronic obstructive pulmonary disease (COPD)
Natasha Smallwood, David Currow, Sara Booth, Anna Spathis, Louis Irving, Jennifer Philip
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3748; DOI: 10.1183/13993003.congress-2016.PA3748

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Physicians' attitudes to dyspnoea management in advanced chronic obstructive pulmonary disease (COPD)
Natasha Smallwood, David Currow, Sara Booth, Anna Spathis, Louis Irving, Jennifer Philip
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3748; DOI: 10.1183/13993003.congress-2016.PA3748
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