RT Journal Article
SR Electronic
T1 Opioids for chronic refractory breathlessness: patient predictors of beneficial response
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj01398-2012
DO 10.1183/09031936.00139812
A1 Miriam J Johnson
A1 J Martin Bland
A1 Stephen G Oxberry
A1 Amy P Abernethy
A1 David C Currow
YR 2012
UL http://erj.ersjournals.com/content/early/2012/12/19/09031936.00139812.abstract
AB Chronic refractory breathlessness is common and distressing in advanced disease. Despite level I evidence to support the use of opioids for this symptom, not all people benefit.Which patient characteristics predict those most likely to gain improvement in breathlessness?This is an international, multi-centre, retrospective analysis of 213 individual pooled datasets from four clinical trials of an opioid for chronic refractory breathlessness. “Response to opioid” was defined: an absolute value of ≥10 ;mm improvement on the visual analogue scale (VAS); a relative value of ≥10% improvement from baseline VAS. We investigated baseline predictors using logistic regression.In the final model, higher baseline breathlessness intensity scores strongly predicted absolute and relative response (p<0.001). Younger age also predicted relative response (p=0.025); functional status and dominant cause of breathlessness did not. Some evidence supported the descriptor “not enough air” but was not statistically significant (p=0.052).A therapeutic trial of opioids is appropriate irrespective of the cause of the breathlessness or functional status. Younger people or those with worse breathlessness are more likely to benefit. Opioids have a role in the management of chronic refractory breathlessness, but net benefit for individuals must be optimised.