Inhaled nebulized and intranasal opioids for the relief of breathlessness

Inhaled nebulized and intranasal opioid administration is available with a proven short onset of action for the relief of pain. As breathlessness episodes are short, these routes of administration seem to be attractive for breathlessness management. This review describes the recent studies evaluating the effectiveness of inhaled nebulized and intranasal application of opioids for patients suffering from refractory breathlessness.

Since 2012, one systematic review and three primary studies have been identified. The systematic review summarized five studies including seventy patients testing nebulized fentanyl and two studies including five patients evaluating intranasal application. Two randomized controlled trials tested inhaled fentanyl or morphine and one retrospective chart review described the application of intranasal fentanyl in newborn babies. Inhaled fentanyl did not improve the intensity or unpleasantness of perceived dyspnea, but the rate of increase in dyspnea intensity and unpleasantness ratings between isotime and peak exercise was less after treatment with fentanyl. Inhaled morphine improved breathlessness in chronic obstructive pulmonary disease patients.

There is currently not enough evidence to support the use of inhaled application of opioids for the relief of breathlessness. There are no controlled trials assessing the efficacy and effectiveness of intranasal opioid application, but a pilot trial is underway to provide preliminary data.