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One evidence base; three stories: do opioids relieve chronic breathlessness?
Magnus Ekström1, Sabrina Bajwah2, J Martin Bland3
1Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Thorax
|April 6, 2017
Summary
Low-dose systemic opioids effectively reduce chronic breathlessness, contrary to a recent review. Re-analysis confirms opioids provide clinically meaningful relief for patients with chronic breathlessness.
Area of Science:
- Palliative Care
- Respiratory Medicine
- Clinical Pharmacology
Background:
- A recent Cochrane review questioned the efficacy of low-dose systemic opioids for chronic breathlessness.
- This re-evaluation addresses limitations in the Cochrane review's methodology, specifically the handling of crossover trial data and risk-of-bias criteria.
Discussion:
- The Cochrane review by Barnes et al. reported smaller effect sizes and lower precision for opioid efficacy.
- This was partly due to not accounting for matched data in crossover trials and incorporating a sample size risk-of-bias criterion.
Key Insights:
- Re-analysis accounting for crossover data demonstrates that systemic opioids significantly decrease breathlessness.
- Opioids reduced breathlessness by a standardized mean difference of -0.32 (95% CI -0.18 to -0.47), a clinically meaningful reduction of 0.8 points on a 0-10 numerical rating scale.
- This finding is consistent across multiple meta-analyses, reinforcing the therapeutic benefit of opioids.
Outlook:
- Further research may focus on optimizing opioid therapy for chronic breathlessness.
- Understanding the nuances of trial data analysis is crucial for accurate efficacy assessments in palliative care.