Nebulised morphine for severe interstitial lung disease.
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.


OBJECTIVE
To assess the effectiveness of nebulized morphine in reducing dyspnoea in patients with end-stage interstitial lung disease


METHODS
RCTs and good quality CCTs were identified by searching Medline, Embase, Cinahl as well as the Cochrane controlled clinical trial register. The following search terms were used: (inhaled OR nebulised)/AND/morphine AND/Idiopathic pulmonary fibrosis/or/pulmonary fibrosis/or/idiopathic interstitial pneumonia/or/nonspecific interstitial pneumonia/or/non-specific interstitial pneumonia/or/usual interstitial pneumonia/or/desquamative interstitial pneumonia/or/cryptogenic fibrosing alveolitis/or/interstitial pneumonia/or/idiopathic interstitial lung disease/or/chronic interstitial pneumonia


METHODS
Any RCT and adequate quality CCT in adult patients with ILD that compared nebulized morphine with a control group.


METHODS
Only one small RCT was identified.


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.


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.
Polosa
R
R
Istituto Malattie Apparato Respiratorio, University of Catania, Via Passo Gravina 187, Catania, Italy. R.Polosa@soton.ac.uk
Simidchiev
A
A
Walters
E H
EH
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002908:Chronic Disease; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D017079:Exercise Tolerance / Q000187:drug effects; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000188:drug therapy*; D009020:Morphine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers
D000701:Analgesics, Opioid; D009020:Morphine