14 Jun, 12 | by BMJ Group
Rocker G, Young J, Donahue M, Farquhar M, Simpson C.
As opioids are recommended for the treatment of refractory dyspnoea in patients with advanced chronic obstructive pulmonary disease (COPD) but not always prescribed, this Canadian study used interviews to explore the views of eight patients and 12 family caregivers as well as 28 physicians toward opioids for dyspnoea in COPD. Patients reported that opioids provided calm and relief from shortness of breath as well as improvements in their quality of life. Caregivers felt that opioids helped patients to breathe more “normally,” improved anxiety and depression, and reduced their level of stress. All patients and family caregivers wanted opioid therapy to continue. The majority of physicians were hesitant to use opioids for dyspnoea, due to a lack of knowledge and experience, as well as fears of adverse effects. The authors suggest the use of initiatives to improve the uptake of guidelines and to increase confidence in prescribing opioids for dyspnoea.
Clemens KE, Faust M, Bruera E.
The evidence for combined modalities of palliative management for breathlessness is reviewed and a structure for its management is devised in this article. Although there are many trials evaluating breathlessness treatment, few of these are well designed, large prospective randomised trials combining pharmacological and non-pharmacological treatments and no trial evaluated the effects of combining treatment modalities. There are also only a few recent treatment recommendations for dyspnoea. The authors recommend the combination of opioids, anxiolytics and corticosteroids alongside physiotherapeutic treatment options and oxygen if indicated.
Flores MP, de Castro AP, Nascimento JD.
Topical administration of drugs may reduce side effects associated with systemically administered drugs. This article reviews the mechanisms of action and clinical efficacy of topical non-steroidal anti-inflammatory Drugs (NSAIDs), local anaesthetics, capsaicin, clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids. It reports that there is evidence to suggest benefit from topical local anaesthetics, NSAIDs and capsaicin, but little data to support the use of topical clonidine, tricyclic antidepressants, ketamine, opioids and cannabinoids. The authors suggest that studies are needed to investigate combination topical therapies.