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Harms of Morphine for Chronic Breathlessness in Relation to Dose, Duration and Titration Phase

Magnus Ekström1, Fatima Alameri1, Sungwon Chang2

  • 1Respiratory Medicine (M.E., F.A.), Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Sweden.

Journal of Pain and Symptom Management
|February 27, 2025
PubMed
Abstract

Insights

The risk of adverse events (AEs) from sustained-release oral morphine for chronic breathlessness in COPD patients was highest in the first week of treatment. Most AEs were mild and resolved without dose adjustment.

Area of Science:

  • Pulmonary Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Severe chronic breathlessness in COPD patients can be treated with morphine.
  • Morphine use may increase the risk of adverse events (AEs).

Purpose of the Study:

  • To evaluate the risk of AEs associated with regular, low-dose sustained-release (SR) oral morphine for chronic breathlessness in COPD patients.
  • To assess the relationship between AEs and morphine dose, treatment duration, and titration phase.

Main Methods:

  • Secondary analysis of a double-blind, randomized trial involving SR morphine titration (0-32 mg/day over three weeks) in COPD patients.
  • Multivariable generalized estimating equation (GEE) models were used to analyze AE risk based on morphine dose, duration, and titration phase (initiation, stable dose, up-titration).

Main Results:

  • Of 156 participants, 64% experienced AEs in week 1.
  • AE risk was highest during the first week of morphine treatment, decreasing significantly in weeks 2 and 3.
  • No statistically significant trend in AE risk was observed with increasing morphine doses (8-32 mg/day) or across different titration phases.

Conclusions:

  • The highest risk of AEs occurred during the initial week of SR oral morphine treatment for chronic breathlessness in COPD patients.
  • AE risk did not significantly differ based on titration phase or daily morphine dose (8-32 mg).
  • Most AEs were manageable and resolved by the end of the titration period.
Keywords:
COPDOpioidsadverse eventsbreathlessnessplacebo controlled trialrandomized controlled trial

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