Patients with advanced COPD usually suffer from progressive dyspnea. Dyspnea defies conventional treatment for 50% patients. Opioids have been advocated as a potential treatment for dyspnea when other therapies fail. Building on the results of a survey we presented at CHEST 2008 we sought to further understand attitudes to use of opioids for advanced COPD among clinicians in Eastern Canada.
We used interpretive description, a qualitative, grounded approach developed to inform clinical practice related to the phenomenon of interest. We conducted one-on-one semi-structured interviews with a purposive sample of 10 Family Physicians (FPs) and 10 Respiratory Therapists (RTs) from southern New Brunswick, Canada. Interviews covered practice type, years of experience, comfort with dyspnea management in advanced COPD, and professionals’ attitudes and barriers to prescriptions of opioids for dyspnea. Interviews were recorded, transcribed verbatim, coded conceptually, and analyzed for themes emerging from within and across interviews.
Senior FPs expressed reluctance to prescribe opioids for dyspnea in advanced COPD unless a patient is “imminently dying.” Respiratory depression is the greatest concern. Younger FPs cited increased exposure to palliative care in training among reasons for increased comfort with prescribing opioids. Community-based RTs follow chronically ill patients to end-of-life and express frustration with suboptimal control of dyspnea. They see a role for opioid therapy but feel few FPs are willing to prescribe.
Risk of respiratory depression remains a fear for many FPs. Patients with advanced COPD often suffer from inadequate control of their dyspnea as they approach the end of their disease trajectories. Inequities in end-of-life care and symptom control for patients with advanced COPD reflect comfort/experience of their physician in this clinical area.
Many physicians retain an aversion to use of opioids for dyspnea in advanced COPD that is not grounded in current evidence. Educational initiatives should focus on solid evidence to overcome long held biases against the use of effective low dose opioid therapy for refractory dyspnea in advanced COPD.
Joanne Young, No Financial Disclosure Information; No Product/Research Disclosure Information