PURPOSE: Symptom relief is a top priority for those living with advanced COPD. Recent ACCP and CTS consensus statements support using opioids for refractory dyspnea, but patient/family experiences of this treatment are mostly unknown. We therefore designed a trial (NCT00982891) to assess effects of opioid therapy for refractory dyspnea in advanced COPD, following participants for 6 months.
METHODS: In this mixed methods study we conducted semi-structured interviews with patients and their caregivers before, at 2 months and at 4-6 months after initiating opioid therapy (using a careful low-dose titration approach) added to conventional therapy for advanced COPD. Formal analysis of verbatim transcriptions of audio-recordings (using interpretive description) will identify commonalities and significant particularities within and across interviews. Quantitative data include measures of dyspnea, quality of life and how helpful (or not) participants found opioid therapy and whether (or not) to continue.
RESULTS: 32 patients are enrolled to date (all MRC 4-5, ages 57-89). Of patients responding to questionnaires at 2 weeks (n=24), all chose to continue opioids, 26/29 have reached 2 months (2 drop outs and one death) and 15/21 6 months (4 dropouts, 1 death). At 2 weeks and 2 months respectively patients found opioids very helpful (27%, 42%), somewhat helpful (50%, 37%) or neutral (23%, 21%). Of patients responding at 4-6 months (n=13) all chose to continue. Preliminary findings from interviews suggest that opioids: 1) improve quality of life for patients which, in turn, improves quality of life for caregivers themselves; 2) provide a sense of hope for the future that was not present beforehand; and 3) that positive impact of opioids may wane over time for some.
CONCLUSIONS: Preliminary findings suggest that carefully titrated opioid therapy added to conventional treatment provides sustained benefits for those living with advanced COPD.
CLINICAL IMPLICATIONS: Opioids appear to be a helpful and acceptable intervention for the longer-term management of refractory dyspnea in advanced COPD.
DISCLOSURE: The following authors have nothing to disclose: Graeme Rocker, Jillian Demmons, Margaret Donahue, Joanne Young, Catherine Simpson, Robert Horton, Paul Hernandez
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