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Vol 12, No 2 (2018)
Review paper
Published online: 2018-06-06
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The use of opioids in the treatment of non-neoplastic pulmonary diseases

Magdalena Renata Osowicka1, Piotr Janowiak2, Agnieszka Gorzewska2
Palliat Med Pract 2018;12(2):118-126.
Affiliations
  1. Department of Palliative Medicine, Debinki 2, 80-211 Gdańsk, Poland
  2. Klinika Alergologii i Pneumonologii GUMed

open access

Vol 12, No 2 (2018)
Review paper
Published online: 2018-06-06

Abstract

Abstract Studies on the endogenous opioid system have demonstrated its presence, including opioid receptors, not only in the central nervous system but also in the respiratory tract. The presence of these receptors, both centrally and peripherally, provides the potential for treatment of respiratory symptoms, such as dyspnea and cough, with systemic and local application of opioids. These are especially important when symptomatic treatment becomes a priority in patient care.

Abstract

Abstract Studies on the endogenous opioid system have demonstrated its presence, including opioid receptors, not only in the central nervous system but also in the respiratory tract. The presence of these receptors, both centrally and peripherally, provides the potential for treatment of respiratory symptoms, such as dyspnea and cough, with systemic and local application of opioids. These are especially important when symptomatic treatment becomes a priority in patient care.

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Keywords

opioids, dyspnoea, cough, palliative care, lung disease

About this article
Title

The use of opioids in the treatment of non-neoplastic pulmonary diseases

Journal

Palliative Medicine in Practice

Issue

Vol 12, No 2 (2018)

Article type

Review paper

Pages

118-126

Published online

2018-06-06

Page views

617

Article views/downloads

588

Bibliographic record

Palliat Med Pract 2018;12(2):118-126.

Keywords

opioids
dyspnoea
cough
palliative care
lung disease

Authors

Magdalena Renata Osowicka
Piotr Janowiak
Agnieszka Gorzewska

References (98)
  1. Uronis HE, Currow DC, Abernethy AP. Palliative management of refractory dyspnea in COPD. Int J Chron Obstruct Pulmon Dis. 2006; 1(3): 289–304.
    PubMed
  2. Jassem E, Batura-Gabryel H, Cofta S, et al. Polskie Towarzystwo Chorób Płuc. [Reccomendation of Polish Respiratory Society for palliative care in chronic lung diseases]. Pneumonol Alergol Pol. 2012; 80(1): 41–64.
    PubMed
  3. Vigeland CL, Hughes AH, Horton MR. Etiology and treatment of cough in idiopathic pulmonary fibrosis. Respir Med. 2017; 123: 98–104.
    CrossRefPubMed
  4. Vicent L, Olarte JM, Puente-Maestu L, et al. Hospital without dyspnea: rationale and design of a multidisciplinary intervention. J Geriatr Cardiol. 2016; 13(7): 625–631.
    CrossRefPubMed
  5. Damps-Konstańska I, Werachowska L, Krakowiak P, et al. Acceptance of home support and integrated care among advanced COPD patients who live outside large medical centers. Appl Nurs Res. 2016; 31: 60–64.
    CrossRefPubMed
  6. Mahler DA, Murray JA, Waterman LA, et al. Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD. Eur Respir J. 2009; 33(4): 771–777.
    CrossRefPubMed
  7. Gifford AH, Mahler DA, Waterman LA, et al. Neuromodulatory effect of endogenous opioids on the intensity and unpleasantness of breathlessness during resistive load breathing in COPD. COPD. 2011; 8(3): 160–166.
    CrossRefPubMed
  8. Bellofiore S, Di Maria GU, Privitera S, et al. Endogenous opioids modulate the increase in ventilatory output and dyspnea during severe acute bronchoconstriction. Am Rev Respir Dis. 1990; 142(4): 812–816.
    CrossRefPubMed
  9. Pattinson KTS. Opioids and the control of respiration. Br J Anaesth. 2008; 100(6): 747–758.
    CrossRefPubMed
  10. Baumgärtner U, Buchholz HG, Bellosevich A, et al. High opiate receptor binding potential in the human lateral pain system. Neuroimage. 2006; 30(3): 692–699.
    CrossRefPubMed
  11. Pattinson KTS, Johnson MJ. Neuroimaging of central breathlessness mechanisms. Curr Opin Support Palliat Care. 2014; 8(3): 225–233.
    CrossRefPubMed
  12. von Leupoldt A, Sommer T, Kegat S, et al. Dyspnea and pain share emotion-related brain network. Neuroimage. 2009; 48(1): 200–206.
    CrossRefPubMed
  13. Parshall MB, Schwartzstein RM, Adams L, et al. American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012; 185(4): 435–452.
    CrossRefPubMed
  14. Mahler DA. Opioids for refractory dyspnea. Expert Rev Respir Med. 2013; 7(2): 123–34; quiz 135.
    CrossRefPubMed
  15. Ekström M, Nilsson F, Abernethy AA, et al. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review. Ann Am Thorac Soc. 2015; 12(7): 1079–1092.
    CrossRefPubMed
  16. Jennings AL, Davies AN, Higgins JPT, et al. A systematic review of the use of opioids in the management of dyspnoea. Thorax. 2002; 57(11): 939–944.
    PubMed
  17. Estfan B, Mahmoud F, Shaheen P, et al. Respiratory function during parenteral opioid titration for cancer pain. Palliat Med. 2007; 21(2): 81–86.
    CrossRefPubMed
  18. Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Manage. 2007; 33(4): 473–481.
    CrossRefPubMed
  19. Colasanti A, Rabiner EA, Lingford-Hughes A, et al. Opioids and anxiety. J Psychopharmacol. 2011; 25(11): 1415–1433.
    CrossRefPubMed
  20. Zebraski SE, Kochenash SM, Raffa RB. Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci. 2000; 66(23): 2221–2231.
    PubMed
  21. Krajnik M, Jassem E, Sobanski P. Opioid receptor bronchial tree: current science. Curr Opin Support Palliat Care. 2014; 8(3): 191–199.
    CrossRefPubMed
  22. Krajnik M, Podolec Z, Siekierka M, et al. Morphine inhalation by cancer patients: a comparison of different nebulization techniques using pharmacokinetic, spirometric, and gasometric parameters. J Pain Symptom Manage. 2009; 38(5): 747–757.
    CrossRefPubMed
  23. Lee AL, Harrison SL, Goldstein RS, et al. Pain and its clinical associations in individuals with COPD: a systematic review. Chest. 2015; 147(5): 1246–1258.
    CrossRefPubMed
  24. Belvisi MG, Hele DJ. Cough sensors. III. Opioid and cannabinoid receptors on vagal sensory nerves. Handb Exp Pharmacol. 2009(187): 63–76.
    CrossRefPubMed
  25. Mahler DA, Selecky PA, Harrod CG, et al. American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest. 2010; 137(3): 674–691.
    CrossRefPubMed
  26. GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2017. Pneumologie. 2017; 71(01): 9–14.
    CrossRef
  27. Marciniuk DD, Goodridge D, Hernandez P, et al. Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011; 18(2): 69–78.
    CrossRefPubMed
  28. Molassiotis A, Bailey C, Caress A, et al. Interventions for cough in cancer. Cochrane Database Syst Rev. 2010(9): CD007881.
    CrossRefPubMed
  29. Wee B, Browning J, Adams A, et al. Management of chronic cough in patients receiving palliative care: review of evidence and recommendations by a task group of the Association for Palliative Medicine of Great Britain and Ireland. Palliat Med. 2012; 26(6): 780–787.
    CrossRefPubMed
  30. Yancy WS, McCrory DC, Coeytaux RR, et al. Efficacy and tolerability of treatments for chronic cough: a systematic review and meta-analysis. Chest. 2013; 144(6): 1827–1838.
    CrossRefPubMed
  31. Morice AH, McGarvey L, Pavord I, et al. British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006; 61 Suppl 1: i1–24.
    CrossRefPubMed
  32. Molassiotis A, Smith J, Mazzone P, et al. Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer. Chest. 2017; 151(4): 861–874.
    CrossRef
  33. Życzkowska J, Wordliczek J. Podskórne i dożylne stosowanie leków przeciwbólowych w medycynie paliatywnej. Med Paliatywna w Prakt. 2010; 4: 6–13.
  34. De Walden-Gałuszko K, Ciałkowska-Rysz A. Medycyna paliatywna. PZWL, Warszawa 2015.
  35. Simon ST, Niemand AM, Benalia H, et al. Acceptability and preferences of six different routes of drug application for acute breathlessness: a comparison study between the United Kingdom and Germany. J Palliat Med. 2012; 15(12): 1374–1381.
    CrossRefPubMed
  36. Jensen D, Alsuhail A, Viola R, et al. Inhaled fentanyl citrate improves exercise endurance during high-intensity constant work rate cycle exercise in chronic obstructive pulmonary disease. J Pain Symptom Manage. 2012; 43(4): 706–719.
    CrossRefPubMed
  37. Masood AR, Thomas SH. Systemic absorption of nebulized morphine compared with oral morphine in healthy subjects. Br J Clin Pharmacol. 1996; 41(3): 250–252.
    PubMed
  38. Davis C, Lam W, Butcher M, et al. Low systemic bioavailability of nebulized morphine: potential therapeutic role for the relief of dyspnoea. In: Proceedings of the Annual Meeting of the American Society of Clinical Oncology. 1992: 359.
  39. Hung OR, Whynot SC, Varvel JR, et al. Pharmacokinetics of inhaled liposome-encapsulated fentanyl. Anesthesiology. 1995; 83(2): 277–284.
    PubMed
  40. Macleod DB, Habib AS, Ikeda K, et al. Inhaled fentanyl aerosol in healthy volunteers: pharmacokinetics and pharmacodynamics. Anesth Analg. 2012; 115(5): 1071–1077.
    CrossRefPubMed
  41. Ward ME, Woodhouse A, Mather LE, et al. Morphine pharmacokinetics after pulmonary administration from a novel aerosol delivery system. Clin Pharmacol Ther. 1997; 62(6): 596–609.
    CrossRefPubMed
  42. Quigley C, Joel S, Patel N, et al. A phase I/II study of nebulized morphine-6-glucuronide in patients with cancer-related breathlessness. J Pain Symptom Manage. 2002; 23(1): 7–9.
    PubMed
  43. Zeppetella G. Nebulized morphine in the palliation of dyspnoea. Palliat Med. 1997; 11(4): 267–275.
    CrossRefPubMed
  44. Tanaka K, Shima Y, Kakinuma R, et al. Effect of nebulized morphine in cancer patients with dyspnea: a pilot study. Jpn J Clin Oncol. 1999; 29(12): 600–603.
    PubMed
  45. Tooms A, McKenzie A, Grey H. Nebulised morphine. The Lancet. 1993; 342(8879): 1123–1124.
    CrossRef
  46. Noseda A, Carpiaux JP, Markstein C, et al. Disabling dyspnoea in patients with advanced disease: lack of effect of nebulized morphine. Eur Respir J. 1997; 10(5): 1079–1083.
    PubMed
  47. Masood AR, Reed JW, Thomas SH. Lack of effect of inhaled morphine on exercise-induced breathlessness in chronic obstructive pulmonary disease. Thorax. 1995; 50(6): 629–634.
    PubMed
  48. Harris-Eze AO, Sridhar G, Clemens RE, et al. Low-dose nebulized morphine does not improve exercise in interstitial lung disease. Am J Respir Crit Care Med. 1995; 152(6 Pt 1): 1940–1945.
    CrossRefPubMed
  49. Jankelson D, Hosseini K, Mather LE, et al. Lack of effect of high doses of inhaled morphine on exercise endurance in chronic obstructive pulmonary disease. Eur Respir J. 1997; 10(10): 2270–2274.
    PubMed
  50. Beauford W, Saylor TT, Stansbury DW, et al. Effects of nebulized morphine sulfate on the exercise tolerance of the ventilatory limited COPD patient. Chest. 1993; 104(1): 175–178.
    PubMed
  51. Leung R, Hill P, Burdon J. Effect of inhaled morphine on the development of breathlessness during exercise in patients with chronic lung disease. Thorax. 1996; 51(6): 596–600.
    PubMed
  52. Young IH, Daviskas E, Keena VA. Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. Thorax. 1989; 44(5): 387–390.
    PubMed
  53. Shohrati M, Ghanei M, Harandi AA, et al. Effect of nebulized morphine on dyspnea of mustard gas-exposed patients: a double-blind randomized clinical trial study. Pulm Med. 2012; 2012: 610921.
    CrossRefPubMed
  54. Bruera E, Sala R, Spruyt O, et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage. 2005; 29(6): 613–618.
    CrossRefPubMed
  55. Farncombe M, Chater S, Gillin A. The use of nebulized opioids for breathlessness: a chart review. Palliat Med. 1994; 8(4): 306–312.
    CrossRefPubMed
  56. Farncombe M, Chater S. Case studies outlining use of nebulized morphine for patients with end-stage chronic lung and cardiac disease. J Pain Symptom Manage. 1993; 8(4): 221–225.
    PubMed
  57. Farncombe M, Chater S. Clinical application of nebulized opioids for treatment of dyspnoea in patients with malignant disease. Support Care Cancer. 1994; 2(3): 184–187.
    PubMed
  58. Cohen SP, Dawson TC. Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics. 2002; 110(3): e38.
    PubMed
  59. Janahi IA, Maciejewski SR, Teran JM, et al. Inhaled morphine to relieve dyspnea in advanced cystic fibrosis lung disease. Pediatr Pulmonol. 2000; 30(3): 257–259.
    PubMed
  60. Davis C, Penn K, et al. A’Hern R, Single dose randomised controlled trial of nebulised morphine in patients with cancer related breathlessness. Palliat Med. 1996; 10: 64–65.
  61. Davis C, Hodder C, Love S, et al. Effect of nebulised morphine and morphine-6-glucuronide on exercise endurance in patients with chronic obstructive pulmonary disease. Thorax. 1994; 49: 393.
  62. Sarhill N, Walsh D, Khawam E, et al. Nebulized hydromorphone for dyspnea in hospice care of advanced cancer. Am J Hosp Palliat Care. 2000; 17(6): 389–391.
    CrossRefPubMed
  63. Charles MA, Reymond L, Israel F. Relief of incident dyspnea in palliative cancer patients: a pilot, randomized, controlled trial comparing nebulized hydromorphone, systemic hydromorphone, and nebulized saline. J Pain Symptom Manage. 2008; 36(1): 29–38.
    CrossRefPubMed
  64. Graff GR, Stark JM, Grueber R. Nebulized fentanyl for palliation of dyspnea in a cystic fibrosis patient. Respiration. 2004; 71(6): 646–649.
    CrossRefPubMed
  65. Coyne P, Viswanathan R, Smith T. Nebulized Fentanyl Citrate Improves Patients' Perception of Breathing, Respiratory Rate, and Oxygen Saturation in Dyspnea. Journal of Pain and Symptom Management. 2002; 23(2): 157–160.
    CrossRef
  66. Kallet RH. The role of inhaled opioids and furosemide for the treatment of dyspnea. Respir Care. 2007; 52(7): 900–910.
    PubMed
  67. Barnes H, McDonald J, Smallwood N, et al. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database Syst Rev. 2016; 3: CD011008.
    CrossRefPubMed
  68. Janowiak P, Krajnik M, Podolec Z, et al. Dosimetrically administered nebulized morphine for breathlessness in very severe chronic obstructive pulmonary disease: a randomized, controlled trial. BMC Pulm Med. 2017; 17(1): 186.
    CrossRefPubMed
  69. Rutherford RM, Azher T, Gilmartin JJ. Dramatic response to nebulized morphine in an asthmatic patient with severe chronic cough. Ir Med J. 2002; 95(4): 113–114.
    PubMed
  70. Stein WM, Min YK. Nebulized morphine for paroxysmal cough and dyspnea in a nursing home resident with metastatic cancer. Am J Hosp Palliat Care. 1997; 14(2): 52–56.
    CrossRefPubMed
  71. An HoJ, Kim IK, Lee JE, et al. Nebulized morphine for intractable cough in advanced cancer: two case reports. J Palliat Med. 2015; 18(3): 278–281.
    CrossRefPubMed
  72. Viola R, Bak K, Cathy K, et al. Cancer Care Ontario’s Symptom Management Guide-to-Practice: Dyspnoea. 2017.
  73. Hui D, Xu A, Frisbee-Hume S, et al. Effects of prophylactic subcutaneous fentanyl on exercise-induced breakthrough dyspnea in cancer patients: a preliminary double-blind, randomized, controlled trial. J Pain Symptom Manage. 2014; 47(2): 209–217.
    CrossRefPubMed
  74. Hui D, Kilgore K, Park M, et al. Impact of Prophylactic Fentanyl Pectin Nasal Spray on Exercise-Induced Episodic Dyspnea in Cancer Patients: A Double-Blind, Randomized Controlled Trial. J Pain Symptom Manage. 2016; 52(4): 459–468.e1.
    CrossRefPubMed
  75. Hui D, Kilgore K, Frisbee-Hume S, et al. Effect of Prophylactic Fentanyl Buccal Tablet on Episodic Exertional Dyspnea: A Pilot Double-Blind Randomized Controlled Trial. J Pain Symptom Manage. 2017; 54(6): 798–805.
    CrossRefPubMed
  76. Simon ST, Kloke M, Alt-Epping B, et al. EffenDys-Fentanyl Buccal Tablet for the Relief of Episodic Breathlessness in Patients With Advanced Cancer: A Multicenter, Open-Label, Randomized, Morphine-Controlled, Crossover, Phase II Trial. J Pain Symptom Manage. 2016; 52(5): 617–625.
    CrossRefPubMed
  77. Juan G, Ramón M, Valia JC, et al. Palliative treatment of dyspnea with epidural methadone in advanced emphysema. Chest. 2005; 128(5): 3322–3328.
    CrossRefPubMed
  78. Shinjo T, Okada M. [Efficacy of controlled-release oxycodone for dyspnea in cancer patients--three case series]. Gan To Kagaku Ryoho. 2006; 33(4): 529–532.
    PubMed
  79. Tanaka M, Maeba H, Senoo T, et al. Efficacy of Oxycodone for Dyspnea in End-stage Heart Failure with Renal Insufficiency. Intern Med. 2018; 57(1): 53–57.
    CrossRefPubMed
  80. Gajewski P, Szczeklik A. Interna Szczeklika. Medycyna Praktyczna, Kraków 2017.
  81. Currow DC, McDonald C, Oaten S, et al. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011; 42(3): 388–399.
    CrossRefPubMed
  82. Booth S, Bausewein C, Higginson I, et al. Pharmacological treatment of refractory breathlessness. Expert Rev Respir Med. 2009; 3(1): 21–36.
    CrossRefPubMed
  83. Varkey B. Opioids for palliation of refractory dyspnea in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2010; 16(2): 150–154.
    CrossRefPubMed
  84. Leppert W. The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemp Oncol (Pozn). 2012; 16(2): 125–131.
    CrossRefPubMed
  85. Yamanaka T, Sadikot RT. Opioid effect on lungs. Respirology. 2013; 18(2): 255–262.
    CrossRefPubMed
  86. Cheatle MD, Webster LR. Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies. Pain Med. 2015; 16 Suppl 1: S22–S26.
    CrossRefPubMed
  87. Caldwell JR, Rapoport RJ, Davis JC, et al. Efficacy and safety of a once-daily morphine formulation in chronic, moderate-to-severe osteoarthritis pain: results from a randomized, placebo-controlled, double-blind trial and an open-label extension trial. J Pain Symptom Manage. 2002; 23(4): 278–291.
    PubMed
  88. Baldo BA, Pham NH. Histamine-releasing and allergenic properties of opioid analgesic drugs: resolving the two. Anaesth Intensive Care. 2012; 40(2): 216–235.
    PubMed
  89. Webster LR. Eight principles for safer opioid prescribing. Pain Med. 2013; 14(7): 959–961.
    CrossRefPubMed
  90. Parmar MS. Exacerbation of asthma secondary to fentanyl transdermal patch. BMJ Case Rep. 2009; 2009.
    CrossRefPubMed
  91. Gaspar C, Alfarroba S, Telo L, et al. End-of-life care in COPD: a survey carried out with Portuguese pulmonologists. Rev Port Pneumol. 2014; 20(3): 123–130.
    CrossRefPubMed
  92. Rocker G, Young J, Horton R. USING OPIOIDS TO TREAT DYSPNEA IN ADVANCED COPD: A SURVEY OF CANADIAN CLINICIANS. Chest. 2008; 134(4).
    CrossRef
  93. Janssen DJA, de Hosson SM, bij de Vaate E, et al. Attitudes toward opioids for refractory dyspnea in COPD among Dutch chest physicians. Chron Respir Dis. 2015; 12(2): 85–92.
    CrossRefPubMed
  94. Ekström MP, Bornefalk-Hermansson A, Abernethy AP, et al. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014; 348: g445.
    PubMed
  95. Vozoris NT, Wang X, Fischer HD, et al. Incident opioid drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J. 2016; 48(3): 683–693.
    CrossRefPubMed
  96. Neutel CI, Johansen HL. Association between hypnotics use and increased mortality: causation or confounding? Eur J Clin Pharmacol. 2015; 71(5): 637–642.
    CrossRefPubMed
  97. Thorns A, Sykes N. Opioid use in last week of life and implications for end-of-life decision-making. Lancet. 2000; 356(9227): 398–399.
    CrossRefPubMed
  98. Chan JD, Treece PD, Engelberg RA, et al. Narcotic and benzodiazepine use after withdrawal of life support: association with time to death? Chest. 2004; 126(1): 286–293.
    CrossRefPubMed

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