TY - JOUR T1 - Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease: A systematic review and meta-analysis JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2015.PA4805 VL - 46 IS - suppl 59 SP - PA4805 AU - Magnus Ekström AU - Fredrik Nilsson AU - Amy Abernethy AU - David Currow Y1 - 2015/09/01 UR - http://erj.ersjournals.com/content/46/suppl_59/PA4805.abstract N2 - Background: Patients with chronic obstructive pulmonary disease commonly suffer from breathlessness, deconditioning, and reduced quality of life (QoL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD.Objective: To estimate the efficacy and safety of opioids on breathlessness, exercise capacity, and quality of life in COPD.Methods: Systematic review and meta-analysis using Cochrane methodology. We searched Cochrane Central Register of Controlled Trials, Medline, and Embase up to 8 September, 2014 for randomized, double-blind, placebo controlled trials of any opioid for breathlessness, exercise capacity, or QoL that included at least one participant with COPD. Effects were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random effect models.Findings: A total of 16 studies (15 crossover trials and one parallel group study; 271 participants; 95% with severe COPD) were included. There were no serious adverse effects. Breathlessness was reduced by opioids overall, SMD -0.35 (95% CI, -0.53 to -0.17; I2, 48.9%), by systemic opioids (8 studies; 118 participants), SMD -0.34 (95% CI, -0.58 to -0.10; I2, 0%), and less consistently by nebulized opioids (4 studies; 82 participants), SMD -0.39 (95% CI, -0.71 to -0.07; I2, 78.9%). Opioids did not affect exercise capacity (13 studies; 149 participants), SMD 0.06 (95% CI, -0.15 to 0.28; I2, 70.7%). QoL could not be analyzed. Findings were robust in sensitivity analyses. Risk of study bias was low or unclear.Conclusion: In severe COPD, opioids improved breathlessness but not exercise capacity. ER -