PURPOSE: A consensus statement recently released by the ACCP supports the use of opioids for refractory dyspnea in patients with advanced lung disease. Symptom relief is a top priority for patients and families living with advanced COPD but their perceptions of using opioids for dyspnea is mostly unknown. We sought to understand the experiences of patients and their family caregivers after patients had been prescribed opioids for dyspnea secondary to advanced COPD.
METHODS: Eighteen participants (patients (n=7, all MRC 5) and family caregivers (n=11), were enrolled to this mixed-methods study. Patients (M=5, F=2, mean (SD) age 71(10) had been using opioids for dyspnea for 2.5 months to 4 years. In semi-structured interviews, patients and caregivers explored experiences of, and attitudes to, opioid use. Interviews were recorded, transcribed verbatim, coded and analyzed (using interpretive description) for themes emerging from within and across interviews. Participants (n=16, excluding 2 bereaved caregivers) also rated how helpful they found opioids (not at all to very helpful) and whether or not they would choose to continue (Y/N).
RESULTS: Patients reported a sense of calm and relief from severe dyspnea when opioids were added to conventional treatments. Family caregivers observed marked differences in patients’ dyspnea, quality of life, anxiety and depression, noting that patients were more relaxed and breathing more "normally". Stress levels also decreased for family caregivers as patients’ breathing improved. All participants chose to continue opioids (patients) or supported their use (caregivers). Patients found opioids to be very (n=4) or somewhat helpful (n=3); caregivers observed them to be very (n=7) or somewhat helpful (n=2).
CONCLUSION: Addition of opioid therapy to conventional treatments for advanced COPD was of benefit over the long term to patients (and to their caregivers).
CLINICAL IMPLICATIONS: Patients and caregivers living with in advanced COPD identify relief of dyspnea as a top priority. More extensive research is required to fully understand experiences and effects of opioid therapy for dyspnea refractory to conventional COPD treatment.
DISCLOSURE: Joanne Young, No Financial Disclosure Information; No Product/Research Disclosure Information