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Opioid treatment in endstage COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • 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


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