Effect of 30 mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD.
OBJECTIVE
We have shown that the administration of 0.8 mg/kg of morphine (M) to patients with COPD resulted in a 20% increase in the maximum oxygen consumption (Vo2max), but was associated with significant drowsiness and euphoria. The objective of the present study was to ascertain whether lower doses of M alone or in combination with prochlorperazine (PC) or promethazine (P) could elicit significant increases in exercise tolerance.


METHODS
The exercise capacity, psychological status, and reaction times were assessed before and 60 min after the patients received placebo (PLAC), 30 mg M orally, 30 mg M plus 10 mg PC (M-PC), or 30 mg M plus 25 mg P (M-P) in a randomized double-blind crossover study. In a secondary study, nine patients were tested on three separate days before and after receiving PLAC, 25 mg P, or 30 mg M plus 25 mg P.


METHODS
Seven COPD patients (FEV1=0.99 +/- 0.30 L, Vo2max=990 +/- 315 mL/min) who were ventilatory-limited.


METHODS
Veterans Affairs medical center.


RESULTS
After the patients ingested M-P, the increase in the Vo2max (129.0 +/- 104 mL/min), the workload (10.0 +/- 6.5 W) and the maximum minute ventilation (4.0 +/- 3.9 L/min) were significantly greater (p<0.05) than after PLAC ingestion (-4.8 +/- 79 mL/min, 1.4 +/- 6.9 W, and -1.6 +/- 2.4 L/min, respectively). Changes after the ingestion of M, P, o r M-PC were intermediate. The M-PC combination adversely affected the patient's reported mental status (Bond visual analog scale) more than the M-P or M regimens. No regimen significantly affected the reaction time.


CONCLUSIONS
We conclude that the administration of 30 mg of M plus 25 mg of P significantly improves the exercise tolerance of patients with COPD, without significantly impairing the mental capabilities of the subjects. The utility of this regimen over longer time periods needs to be evaluated.
Light
R W
RW
Department of Medicine, Veterans Affairs Medical Center, Long Beach, Calif., USA.
Stansbury
D W
DW
Webster
J S
JS
D000284:Administration, Oral; D000368:Aged; D002245:Carbon Dioxide / Q000378:metabolism; D018592:Cross-Over Studies; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D005059:Euphoria / Q000187:drug effects; D017079:Exercise Tolerance / Q000187:drug effects*; D005541:Forced Expiratory Volume / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology*; D008297:Male; D008606:Mental Processes / Q000187:drug effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010101:Oxygen Consumption / Q000187:drug effects; D010919:Placebos; D011346:Prochlorperazine / Q000008:administration & dosage / Q000627:therapeutic use*; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use*; D012123:Pulmonary Ventilation / Q000187:drug effects; D011930:Reaction Time / Q000187:drug effects; D012894:Sleep Stages / Q000187:drug effects
D018492:Dopamine Antagonists; D004338:Drug Combinations; D006634:Histamine H1 Antagonists; D009294:Narcotics; D010919:Placebos; D002245:Carbon Dioxide; D009020:Morphine; D011398:Promethazine; D011346:Prochlorperazine