Recent discoveries from clinical trials: why opioids should not be used for dyspnea management in COPD

Chronic breathlessness among persons with chronic obstructive pulmonary disease (COPD) is a distressing and limiting symptom and a substantial management challenge for healthcare practitioners. Historically, multiple professional respiratory societies have encouraged the prescription of opioid drugs as a therapeutic intervention for chronic breathlessness. However, in 2024, the European Respiratory Society (ERS) published clinical practice guidelines that markedly departed from such traditional recommendations and stated that opioids should not be used for chronic breathlessness.

This manuscript will review recently published, well-designed, randomized controlled trials (literature was searched on PubMed from January 2020 to January 2025) that evaluated the efficacy of oral opioids for chronic breathlessness in persons with COPD and which influenced the new position adopted by ERS in 2024.

Recent, well-designed, adequately powered clinical trials consistently demonstrate that oral opioids are not effective at reducing chronic breathlessness (nor at improving overall quality of life, functional status or exercise tolerance) amongst individuals with advanced COPD. Other professional respiratory societies need to consider and potentially embrace the new ERS position on opioids for dyspnea in COPD, so as to guide members away from an unhelpful, and in some cases harmful, management paradigm.