Grant: Travel Awards - Institute Community Support

Studies published to date have provided little evidence in support of using opioids for the palliation of breathlessness and management of exercise intolerance in patients with advanced Chronic Obstructive Pulmonary Disease (COPD). The purpose of this randomized, double-blind, placebo controlled, crossover trial was to evaluate the safety, efficacy and mechanisms of action of immediate release (IR) oral morphine in relieving exertional breathlessness and improving exercise tolerance in patients with severe to very severe COPD and chronic refractory breathlessness. Results. Compared to placebo, morphine decreased breathlessness intensity and improved exercise endurance time in patients with severe COPD. These improvements occurred in the absence of opioid-related side effects and CO2 retention. In a sub-group analysis, we identified 11 morphine responders (i.e. patients that exhibited morphine-induced decrease in breathlessness intensity) and 9 morphine non-responders. There were no significant differences in baseline clinical and patient-reported characteristics between groups. Implications: IR oral morphine was associated with clinically meaningful relief of breathlessness and improved exercise endurance time in some, but not all patients with advanced COPD. These findings support the use of single-dose IR oral morphine as a safe and effective therapy for the management of chronic refractory breathlessness and exercise intolerance in advanced COPD. Additional research is required to identify the clinical and/or physiological factors responsible for the observed differences in breathlessness relief and improved EET between responders and non-responders.