Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis
Background People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear. Methods We examined the efficacy and safety of opioids for symptom managem...
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2024-10-01
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| Series: | European Respiratory Review |
| Online Access: | http://err.ersjournals.com/content/33/174/230265.full |
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| author | Natasha E. Smallwood Amy Pascoe Marlies Wijsenbeek Anne-Marie Russell Anne E. Holland Lorena Romero Magnus Ekström |
| author_facet | Natasha E. Smallwood Amy Pascoe Marlies Wijsenbeek Anne-Marie Russell Anne E. Holland Lorena Romero Magnus Ekström |
| author_sort | Natasha E. Smallwood |
| collection | DOAJ |
| description | Background
People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear.
Methods
We examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1.
Results
Out of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was “very low” to “low”. Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) −0.37, 95% CI −0.67– −0.07), but not breathlessness measured in daily life (SMD −0.10, 95% CI −0.64–0.44). No effects on HRQoL (SMD −0.42, 95% CI −0.98–0.13) or cough (SMD −1.42, 95% CI −3.99–1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70–6.51), constipation (OR 3.08, 95% CI 1.69–5.61) and drowsiness (OR 1.37, 95% CI 1.01–1.86), with serious adverse events including hospitalisation and death identified.
Conclusions
Opioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits. |
| format | Article |
| id | doaj-art-23ec00ae7dbc4cd38b144042d790a119 |
| institution | DOAJ |
| issn | 0905-9180 1600-0617 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | European Respiratory Review |
| spelling | doaj-art-23ec00ae7dbc4cd38b144042d790a1192025-08-20T02:57:45ZengEuropean Respiratory SocietyEuropean Respiratory Review0905-91801600-06172024-10-013317410.1183/16000617.0265-20230265-2023Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysisNatasha E. Smallwood0Amy Pascoe1Marlies Wijsenbeek2Anne-Marie Russell3Anne E. Holland4Lorena Romero5Magnus Ekström6 Department of Respiratory Medicine, The Alfred Hospital, Prahan, Australia RespiratoryResearch@Alfred, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands Institute of Clinical Sciences, College of Medical and Dental Sciences (MDS) University of Birmingham, Birmingham, UK RespiratoryResearch@Alfred, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia The Ian Potter Library, The Alfred Hospital, Melbourne, Australia Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden Background People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear. Methods We examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1. Results Out of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was “very low” to “low”. Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) −0.37, 95% CI −0.67– −0.07), but not breathlessness measured in daily life (SMD −0.10, 95% CI −0.64–0.44). No effects on HRQoL (SMD −0.42, 95% CI −0.98–0.13) or cough (SMD −1.42, 95% CI −3.99–1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70–6.51), constipation (OR 3.08, 95% CI 1.69–5.61) and drowsiness (OR 1.37, 95% CI 1.01–1.86), with serious adverse events including hospitalisation and death identified. Conclusions Opioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits.http://err.ersjournals.com/content/33/174/230265.full |
| spellingShingle | Natasha E. Smallwood Amy Pascoe Marlies Wijsenbeek Anne-Marie Russell Anne E. Holland Lorena Romero Magnus Ekström Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis European Respiratory Review |
| title | Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis |
| title_full | Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis |
| title_fullStr | Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis |
| title_full_unstemmed | Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis |
| title_short | Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis |
| title_sort | opioids for the palliation of symptoms in people with serious respiratory illness a systematic review and meta analysis |
| url | http://err.ersjournals.com/content/33/174/230265.full |
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