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%) | ||
| Male | 116 (63%) | 71 (27%) | |
| Years in specialty practice (median) | 13 | 12 | |
| Australia | 156 (85%) | 98 (37%) | |
| New Zealand | 27 (15%) | 31 (12%) | |
| UK | 0 | 134 (51%) | |
| Uses dyspnoea score routinely | 59 (32%) | 47 (18%) | |
| Add dyspnoea medication | 127 (69%) | 239 (91%) | |
| Recommended treatment for refractory dyspnoea | Short acting morphine 2.5-5mg 4-6hrly PRN | 74 (58%) | 197 (82%) |
| Long acting morphine 10-20mg/24hrs | 20 (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.
- Copyright ©the authors 2016
