Oral transmucosal fentanyl citrate for dyspnea in terminally ill patients: an observational case series

To evaluate the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) in terminally ill patients experiencing dyspnea.

Nonblinded, non-controlled observational study of patients admitted to the hospice/palliative care unit for dyspnea from May 2006 to March 2007. Eligible patients were older than 18 years of age with satisfactory baseline cognitive function diagnosed with end-stage congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or cancer complaining of dyspnea. At the onset of dyspnea, enrolled patients were instructed to slowly dissolve the OTFC lozenge and rate their dyspnea on a 10 point visual analog scale at 15-minute intervals for 60 minutes. Respiratory rate (RR) and arterial oxygen saturation (SaO(2)) were recorded at similar intervals. Patients were observed for approximately 48 hours.

Four patients were found eligible. In all four cases, patients experienced rapid relief of dyspnea as soon as five minutes. No significant adverse events were reported.

OTFC appears to be safe and effective for dyspnea in terminally ill patients. The study population is limited to four cases, however, the initial findings are promising and merit further research.