Sertraline has no role in the management of chronic breathlessness in patients with advanced disease such as COPD, primary lung cancer and other restrictive lung disease.

An Australian study randomised 249 patients to either daily oral sertraline (25-100mg) or placebo in addition to their usual care and up to eight doses of immediate release oral morphine (2.5mg) as needed.

The majority of participants (77%) had normal or mild scores for anxiety at baseline based on the Hospital Anxiety and Depression Scale (HADS).

The patients’ experience of breathlessness decreased from baseline in both arms of the study but with no significant difference between arms.

At the end of the study, 36.1% of participants on sertraline felt an appreciable improvement in their symptoms compared to 41.3% on placebo.

“There was no net benefit observed for sertraline on chronic breathlessness in participants who had undergone optimal treatment for the underlying cause(s) in this multi-site RCT,” said the study investigators, led by palliative care specialist Professor David Currow.

However, given the low proportion of patients in the study with high levels of anxiety, there was a case for further research in this sub-group, they suggested.

“To date the best quality evidence for relief of chronic breathlessness remains with morphine, and concerns around the potentially rare but catastrophic side effect of respiratory depression are slowly abating, primarily due to evidence that regular, low-dose, extended release morphine, which minimises peak drug concentrations, dose not appear to be associated with this effect in steady state,” they concluded.