Nebulized Opioids for Hospice Patients
Posted by Dr. Jim Joyner
Can opioids be administered by nebulizer for shortness of breath (dyspnea)?
Opioids are the mainstay of treatment for management of severe dyspnea in hospice patients with late stage CHF and COPD. The use of opioids in dyspnea is supported by extensive experience as well as clinical studies with the use of both oral and parenteral opioids, specifically morphine. The mechanism of action is unclear and it is interesting that opioids can alleviate dyspnea in many patients without changing the respiratory rate or producing any measurable changes in blood gas parameters. The rationale for considering nebulized opioids centers on the belief that dyspnea can be relieved while avoiding potential systemic side effects associated with oral or parenteral routes. The current medical literature does not support this belief. A review article by Foral (1) and colleagues in 2004 evaluated a number of clinical studies in patients being treated for dyspnea with inhaled nebulized opioids. The authors concluded that the evidence did not support the use of nebulized morphine for the relief of dyspnea. They also reported that in all cases opioid side effects were present from mild to moderate degree. There are several other options available for conventional opioid administration routes for hospice patients, including: oral, subcutaneous, intramuscular, intravenous, rectal, transmucosal, and sublingual.
(1) Nebulized Opioids use in COPD. Chest 2004;125:363-365