Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease a systematic review

Ekström, M; Nilsson, F; Abernethy, AA; Currow, DC

Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease a systematic review

Ekström, M Nilsson, F Abernethy, AA Currow, DC

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Publication Type:: Journal Article
Citation:: Annals of the American Thoracic Society, 2015, 12 (7), pp. 1079 - 1092
Issue Date:: 2015-01-01

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Field	Value	Language
dc.contributor.author	Ekström, M	en_US
dc.contributor.author	Nilsson, F	en_US
dc.contributor.author	Abernethy, AA	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.date.issued	2015-01-01	en_US
dc.identifier.citation	Annals of the American Thoracic Society, 2015, 12 (7), pp. 1079 - 1092	en_US
dc.identifier.issn	2325-6621	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118545
dc.description.abstract	Copyright © 2015 by the American Thoracic Society. Rationale: Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD. Objectives: We aimed to estimate the efficacy and safety of opioids on refractory breathlessness, exercise capacity, and HRQL in COPD. Methods: This was a systematic review and metaanalysis using Cochrane methodology. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to 8 September, 2014 for randomized, double-blind, placebo-controlled trials of any opioid for breathlessness, exercise capacity, or HRQL that included at least one participant with COPD. Effects were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random effect models. Measurements and Main Results: A total of 16 studies (15 crossover trials and 1 parallel-group study, 271 participants, 95% with severe COPD) were included. There were no serious adverse effects. Breathlessness was reduced by opioids overall: SMD, 20.35 (95% CI, 20.53 to 20.17; I<sup>2</sup>, 48.9%), by systemic opioids (eight studies, 118 participants): SMD, 20.34 (95% CI, 20.58 to 20.10; I<sup>2</sup>, 0%), and less consistently by nebulized opioids (four studies, 82 participants): SMD, 20.39 (95% CI, 20.71 to 20.07; I<sup>2</sup>, 78.9%). The quality of evidence was moderate for systemic opioids and low for nebulized opioids on breathlessness.Opioids did not affect exercise capacity (13 studies, 149 participants): SMD, 0.06 (95% CI, 20.15 to 0.28; I<sup>2</sup>, 70.7%). HRQL couldnot be analyzed. Findingswere robust in sensitivity analyses.Risk of study bias was low or unclear. Conclusions: Opioids improved breathlessness but not exercise capacity in severe COPD.	en_US
dc.relation.ispartof	Annals of the American Thoracic Society	en_US
dc.relation.isbasedon	10.1513/AnnalsATS.201501-034OC	en_US
dc.subject.classification	Respiratory System	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive	en_US
dc.subject.mesh	Dyspnea	en_US
dc.subject.mesh	Analgesics, Opioid	en_US
dc.subject.mesh	Exercise Tolerance	en_US
dc.subject.mesh	Quality of Life	en_US
dc.subject.mesh	Randomized Controlled Trials as Topic	en_US
dc.title	Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease a systematic review	en_US
dc.type	Journal Article
utslib.citation.volume	7	en_US
utslib.citation.volume	12	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	7	en_US
pubs.publication-status	Published	en_US
pubs.volume	12	en_US

Abstract:

Copyright © 2015 by the American Thoracic Society. Rationale: Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD. Objectives: We aimed to estimate the efficacy and safety of opioids on refractory breathlessness, exercise capacity, and HRQL in COPD. Methods: This was a systematic review and metaanalysis using Cochrane methodology. We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to 8 September, 2014 for randomized, double-blind, placebo-controlled trials of any opioid for breathlessness, exercise capacity, or HRQL that included at least one participant with COPD. Effects were analyzed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random effect models. Measurements and Main Results: A total of 16 studies (15 crossover trials and 1 parallel-group study, 271 participants, 95% with severe COPD) were included. There were no serious adverse effects. Breathlessness was reduced by opioids overall: SMD, 20.35 (95% CI, 20.53 to 20.17; I², 48.9%), by systemic opioids (eight studies, 118 participants): SMD, 20.34 (95% CI, 20.58 to 20.10; I², 0%), and less consistently by nebulized opioids (four studies, 82 participants): SMD, 20.39 (95% CI, 20.71 to 20.07; I², 78.9%). The quality of evidence was moderate for systemic opioids and low for nebulized opioids on breathlessness.Opioids did not affect exercise capacity (13 studies, 149 participants): SMD, 0.06 (95% CI, 20.15 to 0.28; I², 70.7%). HRQL couldnot be analyzed. Findingswere robust in sensitivity analyses.Risk of study bias was low or unclear. Conclusions: Opioids improved breathlessness but not exercise capacity in severe COPD.

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