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Nebulised morphine for dyspnoea

 

Clinical bottom line

There was no convincing evidence that nebulised morphine was beneficial in chronic lung disease up to mid-2004.


Reference:

SJ Brown et al. Nebulized morphine for relief of dyspnea due to chronic lung disease. Annals of Pharmacotherapy 2005: 39 (published online DOI 10.1345/aph.1E328).


Systematic review

This was an apparent systematic review, in that it featured a systematic search for studies of nebulised morphine in chronic lung disease up to mid-2004. Information on the studies found is provided in tables. There were no inclusion criteria, but information is provided about randomisation and blinding.

Results

Nine studies were found, five (four randomised, all blind) in COPD, one (randomised and blind) in interstitial lung disease, and three (none randomised, or blind) in cancer or terminal illness. The studies were all small, with between eight and 16 patients each. Usually they tested a single morphine dose, between about 1 mg and 40 mg.

None of the five studies in COPD or the one study in interstitial lung disease found any meaningful benefit from nebulised morphine. There were suggestions that nebulised morphine had some benefit in terminal illness, but these were open-label, and the biggest benefit was seen in an uncontrolled study.

Comment

At least up to mid-2004, there was no convincing evidence that nebulised morphine was beneficial in chronic lung disease.