PURPOSE: Fifty percent of patients with advanced COPD suffer from dyspnea that defies conventional COPD treatments. The ACCP recently released a consensus report that supports the use of opioids as a treatment for dyspnea when other therapies fail. We sought to further understand attitudes to use of opioids for dyspnea among various physicians in Eastern Canada.
METHODS: We conducted semi-structured interviews with a sample of 18 physicians from three centres in Nova Scotia, Canada: Family Medicine n=8; Respirologists n=4, Internal Medicine n=3, and Palliative Medicine n=3. Interviews covered: years of experience, comfort with managing dyspnea that is secondary to advanced COPD, and professionals’ perceived barriers/facilitators to prescribing opioids for dyspnea in a COPD context. Interviews were recorded, transcribed verbatim, coded conceptually, and analyzed (using interpretive description) for themes emerging from within and across interviews.
RESULTS: Palliative Medicine physicians felt informed and comfortable to use opioids for dyspnea in patients with advanced COPD. Physicians from other disciplines expressed varying degrees of comfort and some reluctance in prescribing opioids in this context. Lack of education, training, and guidelines were cited as reasons for reluctance to prescribe opioids for dyspnea in patients with COPD. Many physicians expressed frustration with suboptimal control of dyspnea and a desire to learn about new potential treatments. Some physicians suggested that palliative care interventions (opioids) may not be used enough in this patient population. Risk of respiratory depression remains a concern.
CONCLUSION: Inequities in end-of-life care and inadequate symptom control for patients with advanced COPD reflect comfort/experience of their physicians in this clinical area rather than evidence-based practice. Risk of respiratory depression remains a concern for many physicians.
CLINICAL IMPLICATIONS: Many physicians are averse to using opioids as a treatment for dyspnea in advanced COPD. For ACCP recommendations to be followed, we need educational initiatives focused on solid evidence to overcome long held biases against the use of a treatment that is often effective in treating dyspnea in advanced COPD.
DISCLOSURE: Joanne Young, No Financial Disclosure Information; No Product/Research Disclosure Information