Chest
Clinical InvestigationsEffects of Nebulized Morphine Sulfate on the Exercise Tolerance of the Ventilatory Limited COPD Patient
Section snippets
Ritient Selection
Eight COPD patients were studied. Inclusion criteria for the study included an FEV1 below 1.4 L, FEV1/FVC below 0.50, exercise limited by breathlessness, and a stable disease state. Patients were excluded if they met any of the following criteria: (1) PaCO2 above 45 mm Hg; (2) long-term oxygen therapy; (3) known cardiac disease, including left ventricular dysfunction, previous myocardial infarction, angina pectoris, arrhythmias requiring pharmacologic therapy, or hypertension requiring more
Results
The characteristics of the seven male patients and one female patient who completed the protocol are shown in Table 1. The average patient was elderly with severe COPD. The exercise capability was severely reduced with a mean o2max of 950±264 ml/min and a mean maximal workload of less than 80 W. The patients appeared to be ventilatory limited since the mean Emax/FEV1 was 39.4, the mean R increased only 0.07 from rest to Emax, the mean Borg score at Emax was 8.4±2.2, and the mean
Discussion
This present study demonstrates that the administration of 1 to 10 mg of morphine sulfate by a nebulizer does not have a significant effect on the exercise tolerance of patients who are ventilatory limited from COPD. There is a tendency for the exercise tolerance to increase with the largest dose. Since the mental function is not affected by this dose and there were no other discernible side effects, additional studies with larger doses of aerosolized opiates may be warranted.
Previous studies
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Cited by (63)
Emerging opioid alternatives to nebulized fentanyl for improving exercise capacity in patients with COPD
2012, Journal of Pain and Symptom ManagementInhaled fentanyl citrate improves exercise endurance during high-intensity constant work rate cycle exercise in chronic obstructive pulmonary disease
2012, Journal of Pain and Symptom ManagementCitation Excerpt :Under these circumstances, consideration may be given to alternative interventions for symptom relief, such as inhaled nebulized opioids. As reviewed in detail elsewhere,3–5 only a few randomized, double-blind, placebo-controlled, crossover studies have examined the effect of inhaled nebulized opioids on exercise tolerance and/or exertional dyspnea in patients with chronic lung disease.6–11 The collective results of Harris-Eze et al.,6 Masood et al.,8 Beauford et al.,9 and Leung et al.10 suggest that compared with placebo, single-dose inhalation of nebulized morphine—a μ-opioid agonist—at doses ranging from 1 to 25 mg improves neither the intensity of exertional dyspnea nor the maximal work rate (Wmax) achieved during symptom-limited incremental cycle exercise in patients with COPD and interstitial lung disease.
Gaps in the evidence base of opioids for refractory breathlessness. A future work plan?
2012, Journal of Pain and Symptom ManagementCitation Excerpt :As such, an adequately designed and executed trial of nebulized opioids is required before a benefit from this form of administration can be excluded. Since then, there have been several more studies of nebulized opioids (fentanyl, morphine, and hydromorphone),15,29–33 the results of which follow a pattern according to study design. Randomized studies that measured dyspnea (two with morphine, and one with hydromorphone) had negative findings,29,32,33 but the small observational cohort of nebulized fentanyl (n = 35) showed benefit,30 as did the single case report.31
Effect of low dose nebulized morphine on respiratory function improvement in mustard gas-exposed patients: A double-blind crossover clinical trial study
2022, Caspian Journal of Internal MedicineImproving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD
2022, International Journal of COPD
Presented in part at the Annual Meeting, American Thoracic Society, Anaheim, Calif, May 1991.
Supported in part by the Research Service of the Department of Veterans Affairs.
Manuscript received August 18, revision November 23.