Nebulised morphine for severe interstitial lung disease

Abstract

Background: The evidence to support the use of nebulized morphine to improve dyspnoea and exercise limitation in terminally ill patients with chronic lung disease is conflicting. Objectives: To assess the effectiveness of nebulized morphine in reducing dyspnoea in patients with end-stage interstitial lung disease (ILD). Search strategy: We identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE and EMBASE. Searches are current to May 2009. Selection criteria: Any RCT and adequate quality CCT in adult participants with ILD that compared nebulized morphine with a control group. Data collection and analysis: Only one small RCT was identified. Data were extracted and described narratively. Main results: Compared to placebo (normal saline), administration of low-dose nebulized morphine (2.5 and 5.0 mg) to six patients with ILD did not improve maximal exercise performance, and did not reduce dyspnoea during exercise. An update search identified an additional excluded study . Authors' conclusions: The hypothesis that nebulized morphine may reduce dyspnoea in patients with interstitial lung disease has not been confirmed in the single small RCT identified. Nebulised morphine for severe interstitial lung disease: Nebulized morphine has been reported to have some beneficial effect on breathlessness and exercise limitation in terminally ill patients with chronic lung disease. Patients with end-stage interstitial lung disease might also benefit from treatment of breathlessness with nebulized morphine. This review evaluates the effectiveness of using nebulized morphine for breathlessness reduction in patients with interstitial lung disease. Only one small randomised controlled trial was identified. This study concluded that low-dose nebulized morphine is of no benefit in the management of exercise-induced dyspnoea and exercise limitations in patients with interstitial lung disease. However, the patients included in this study were relativelymild, and definitive conclusions on the effect of nebulized morphine in the reduction of dyspnoea in end-stage interstitial lung disease requires further work. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.