The dyspnea target: can we zero in on opioid responsiveness in advanced chronic obstructive pulmonary disease?

Despite recognition that opioids alleviate dyspnea in chronic obstructive pulmonary disease, many clinicians remain reluctant to use them outside of the final days of life. This article defines the term 'opioid responsiveness' as it pertains to dyspnea, and poses that it may be possible to predict more accurately the patients with chronic obstructive pulmonary disease and refractory dyspnea who might benefit from opioid treatment for either short-term use during episodes of dyspnea crisis or for long-term use for chronic dyspnea on minimal exertion.

This article highlights recent evidence of known dimensions contributing to the sensation of dyspnea in chronic obstructive pulmonary disease and builds on clinical observational experience to generate a conceptual model of opioid responsiveness. The 'dyspnea target' and 'opioid responsiveness score' are proposed as a means of defining more clearly the sensations encountered by a given patient and the likelihood of symptomatic improvement in response to opioids.

The 'dyspnea target' or similar conceptual models that attempt to predict how specific aspects of dyspnea may affect response to treatments offer clinicians the potential to more effectively target interventions. The model is presented in its theoretical stage in order to stimulate further discussion and research in an area of current interest.