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Fentanyl or morphine for persistent dyspnoea in COPD: a multicentre randomised crossover trial
Marlies van Dijk1,2, Kris J M Mooren3, Wendy van Beurden-Moeskops4
1Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands m.van.dijk05@umcg.nl.
The European Respiratory Journal
|June 4, 2026
Summary
Transdermal fentanyl and oral morphine did not improve persistent dyspnea in patients with chronic obstructive pulmonary disease (COPD). Neither opioid offered clinical benefits over placebo for breathing difficulties or related symptoms.
Area of Science:
- Pulmonary Medicine
- Pharmacology
- Palliative Care
Background:
- Persistent dyspnea is a significant symptom in advanced chronic obstructive pulmonary disease (COPD).
- Opioids like morphine are suggested for dyspnea in palliative care, but recent trials show limited benefit and adverse event concerns.
- Transdermal fentanyl has not been studied for persistent dyspnea in COPD.
Purpose of the Study:
- To investigate the efficacy of transdermal fentanyl and oral morphine compared to placebo for persistent dyspnea in COPD patients.
- To evaluate the impact of these treatments on dyspnea severity, health status, anxiety, and sleep quality.
Main Methods:
- A multicenter, cross-over, double-dummy randomized controlled trial (RCT).
- Participants received transdermal fentanyl, oral morphine, or placebo for two-week periods with washout.
- Inclusion criteria: persistent dyspnea (mMRC score ≥3) in COPD (FEV1 <50%) despite optimal therapy.
Main Results:
- No significant differences were found between transdermal fentanyl, oral morphine, and placebo for mean or worst daily dyspnea.
- Secondary outcomes including health status, anxiety, hypercapnia, mastery, and sleep quality showed no significant improvements.
- No significant differences in overall side effects were observed, though vomiting was noted with fentanyl/morphine.
Conclusions:
- Transdermal fentanyl and oral morphine do not provide a clinical benefit for persistent dyspnea in COPD patients compared to placebo.
- The findings challenge the current use of these opioids for managing severe dyspnea in advanced COPD.
- Further research may be needed to explore alternative treatments for this debilitating symptom.
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