Low-Dose Morphine for Dyspnea in Terminally Ill Patients with Idiopathic Interstitial Pneumonias

Area of Science:

• Pulmonology
• Palliative Care
• Pharmacology

Background:

• Dyspnea is a common and debilitating symptom in patients diagnosed with idiopathic interstitial pneumonias (IIPs).
• Effective management of dyspnea is crucial for improving the quality of life in terminally ill patients with IIPs.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous subcutaneous morphine administration for managing dyspnea.
• To assess the impact of morphine on dyspnea severity and respiratory rate in terminally ill IIP patients.

Main Methods:

• Retrospective review of terminally ill idiopathic interstitial pneumonia patients receiving continuous subcutaneous morphine for dyspnea.
• Dyspnea severity assessed via Numerical Rating Scale (NRS) and respiratory rate (RR) recorded pre-treatment and at 2 and 4 hours post-initiation.
• Subgroup analysis conducted for patients with and without noninvasive positive pressure ventilation (NPPV).

Main Results:

• Dyspnea NRS scores significantly decreased at 4 hours post-morphine initiation (p=0.04) compared to baseline.
• Respiratory rate (RR) did not show significant changes at 2 or 4 hours post-treatment.
• Patients not using NPPV experienced significant dyspnea improvement, while NPPV users did not show significant improvement.

Conclusions:

• Continuous subcutaneous morphine may be a beneficial option for alleviating dyspnea in terminally ill IIP patients.
• The observed benefits occurred without a significant reduction in respiratory rate, suggesting a favorable safety profile.
• Further research may be warranted to explore optimal use in patients requiring ventilatory support.