Patients with advanced COPD experience significant symptom burden, particularly dyspnea, that is often refractory to conventional treatment. While opioids can relieve dyspnea, we know little about their use among those dying with COPD. The purpose of our study was to explore opioid use in the last year of life among patients with COPD.
A retrospective study was conducted using a Saskatchewan Health administrative database. Decedents from 2004 were selected (n=1035) who had either lung cancer (n=433) or COPD (n=602) as the underlying or a contributing cause of death. Outcomes of interest included palliative care involvement, whether or not a community prescription was filled for any opioid, opioid prescribing patterns over the last months before death and whether prescribing habits varied by disease or according to place of death (home, long stay facility or hospital).
Compared to those with COPD, consistent and significantly (p<0.05) higher proportions of patients with lung cancer filled prescriptions within the last seven days, last month or last three months for oral morphine, (Table 1), oral hydromorphone and transdermal fentanyl. Significantly more persons who died with lung cancer (37.4%) received home palliative care services than those who died with COPD (2.8%, p <0.005). Persons who died in a long-term care institution were more likely than those who died in hospital to have had prescriptions filled in the last three months of life for: any opioid (OR 3.37 95% CI 2.21–4.98) as were those who died at home (OR 2.09, 1.31–3.33).
Opioids are prescribed for relatively small proportions of patients with COPD at the end of life. Prescriptions for opioidswere more often filled when patients died at home or in long term facilities.
Despite a 50% prevalence of refractory dyspnea in end stage COPD, most patients do not receive palliative home care or palliation with opioid. Future research is needed to explore the efficacy and safety of opioids for patients living and dying with advanced COPD, and whether their limited use is justified.
Donna Goodridge, No Financial Disclosure Information; No Product/Research Disclosure Information