Short on drug options for short of breath patients

Morphine is still the best pharmacological treatment for chronic breathlessness, according to an extensive review of the literature.

Co-author of the review published in Expert Review of Respiratory Medicine  Professor David Currow told the limbic the inability to tolerate morphine was relatively rare however some physician resistance remained due to confusion about the risk of respiratory depression.

“Regular low-dose, extended-release morphine is safe and effective at reducing breathlessness in a clinically meaningful way,” he told the limbic.

Professor Currow, from the University of Technology Sydney and palliative and supportive services at Flinders University, said about 1 in 300 people with chronic breathlessness were housebound because of  their symptoms.

The size of the problem suggested a degree of uncertainty from clinicians about how to treat breathlessness.

“Many non-pharmacological interventions such as relaxation, guided imagery, activity pacing and breathing techniques are very important in managing breathlessness. The move to pharmacological treatment should only be when those non-pharmacological options are either inappropriate or exhausted.”

The review found no evidence of benefit from anxiolytics such as benzodiazepines and buspirone.

“We talk about the breathlessness-anxiety-breathlessness cycle but anxiety as a primary cause of breathlessness is rare,” he said.

“Anxiolytics might take the edge off acute breathlessness such as in pneumonia in the short-term, but their use is unlikely to show benefit in the long-term.”

He said there was interest in, but as yet insufficient evidence for the role of serotonin in modulating perception of breathlessness. However an Australian study of sertraline for palliative management of refractory breathlessness is expected to deliver results later this year.

Some evidence was found for nebulised inhaled furosemide to reduce chronic breathlessness in COPD exacerbations, however more research was required.

The review found little data for the use of cannabinoids and some evidence for traditional Chinese medicines such as Bu-Fei Jian-Pi, Bu-Fei Yi-Shen and Yi-Qi Zi-Shen granules. However more research was required especially regarding potential toxicities.

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