Treating Refractory Dyspnea in Advanced COPD: Patient and Caregiver Experiences of Opioid Therapy

Abstract

Background: A recent ACCP consensus statement supports the use of opioids for refractory dyspnea in patients with advanced lung disease. Symptom relief is a top priority for patients and families living with advanced COPD but patients' experiences of using opioids for dyspnea is mostly unknown and is the subject of this study. Methods: Eighteen participants (patients n=7, all MRC 5) and family caregivers (n=11), were enrolled to this mixed-methods study. Patients (M=5, F=2, mean (SD) age 71(10) had been using opioids for dyspnea for 2.5 months to 4 years. In semi-structured interviews, with patients (P) and caregivers (C) we explored experiences of, and attitudes to, opioid use. Interviews were recorded, transcribed verbatim, coded and analyzed (using interpretive description) for themes emerging from within and across interviews. Participants (n=16, excluding 2 bereaved caregivers) also rated how helpful/unhelpful they found opioids and whether or not they would choose to continue (Y/N). Results: Patients reported a sense of calm and relief from severe dyspnea. Family caregivers observed marked differences in patients' dyspnea, quality of life, anxiety and depression, noting that patients were breathing more “normally”. Their own stress levels fell. All participants chose to continue opioids (P) or supported their use (C). Patients found opioids to be very (n=4) or somewhat helpful (n=3); caregivers observed them to be very (n=7) or somewhat helpful (n=2). Conclusions: Opioids added to conventional treatments for advanced COPD were of benefit over the long term to both patients and caregivers. Clinical Implications: Patients and caregivers living with advanced COPD identify relief of dyspnea as a top priority. More extensive research is required to fully understand experiences and effects of opioid therapy for dyspnea refractory to conventional COPD treatment.