Real‐world opioid prescription to patients with serious, non‐malignant, respiratory illnesses and chronic breathlessness

BACKGROUND: Chronic breathlessness is a disabling symptom that is often under‐recognised and challenging to treat despite optimal disease‐directed therapy. Low‐dose, oral opioids are recommended to relieve breathlessness, but little is known regarding long‐term opioid prescription in this setting. AIM: To investigate the long‐term efficacy of, and side‐effects from, opioids prescribed for chronic breathlessness to patients with advanced, non‐malignant, respiratory diseases. METHODS: A prospective cohort study of all patients managed by the advanced lung disease service, an integrated respiratory and palliative care service, at the Royal Melbourne Hospital from 1 April 2013 to 3 March 2020. RESULTS: One hundred and nine patients were prescribed opioids for chronic breathlessness. The median length of opioid use was 9.8 (interquartile range (IQR) = 2.8–19.8) months. The most commonly prescribed initial regimen was an immediate‐release preparation (i.e. Ordine) used as required (37; 33.9%). For long‐term treatment, the most frequently prescribed regimen included an extended‐release preparation with an as needed immediate‐release (37; 33.9%). The median dose prescribed was 12 (IQR = 8–28) mg oral morphine equivalents/day. Seventy‐one (65.1%) patients reported a subjective improvement in breathlessness. There was no significant change in the mean modified Medical Research Council dyspnoea score (P = 0.807) or lung function measurements (P = 0.086–0.727). There was no association between mortality and the median duration of opioid use (P = 0.201) or dose consumed (P = 0.130). No major adverse events were reported. CONCLUSION: Within this integrated respiratory and palliative care service, patients with severe, non‐malignant respiratory diseases safely used long‐term, low‐dose opioids for breathlessness with subjective benefits reported and no serious adverse events.