Opioid treatment in endstage COPD

• Therapy relevant to all patients with COPD:
  • palliative treatment for dyspnoea (1):
    • opiates, neuromuscular electrical stimulation (NMES), chest wall vibration (CWV) and fans blowing air onto the face can help in breathlessness
    • immediate-release morphine extended exercise endurance time in over half of patients with advanced COPD, although further research is required to determine what patient characteristics predict response
    • oxygen may offer some benefit even if the patient is not hypoxemic (Sp02 > 92%)
    • pulmonary rehabilitation is effective and in severe cases non-invasive ventilation can also reduce daytime breathlessness
    • acupuncture and acupressure are other non-pharmacological approaches in patients with advanced COPD that may improve breathlessness and quality of life
    • refractory dyspnea may be more effectively managed with a multidisciplinary integrated palliative and respiratory care service
    • There is no evidence for a beneficial effect of benzodiazepines and there is not enough data to recommend distractive auditory stimuli (music), relaxation, counseling and support, with our without breathing relaxation training, or psychotherapy.
  • nutritional support
    • if a COPD patient is malnourished, then nutritional supplementation to gain weight will lead to significant improvements in respiratory muscle strength and overall health-related quality of life
  • cognitive behavioural therapy and mind body interventions (yoga, relaxation etc) may help in reducing anxiety and depression

Patients with end-stage COPD and their family and carers should have access to the full range of services offered by multidisciplinary palliative care teams, including admission to hospices

Reference:

• (1) Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease
• (2) National Institute for Health and Clinical Excellence (NICE) 2018. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.