title: Nebulized opioids use in COPD.
abstract: OBJECTIVE
  To evaluate the role of nebulized opioids in COPD.
  
  
  METHODS
  A MEDLINE search was completed to obtain pertinent clinical literature. Key search terms included the following: nebulizer, opioids, COPD, dyspnea, morphine, and hydromorphone.
  
  
  RESULTS
  Currently, the evidence in the literature is lacking regarding placebo-controlled studies to support nebulized morphine for the relief of dyspnea in patients with COPD. The studies reviewed varied considerably in the dose, opioid used, administration schedule, and methodology. One study found improved exercise capacity in 11 patients not reproducible in a larger sample, and another study found benefit in 54 terminal patients. All other studies found no benefit.
  
  
  CONCLUSIONS
  The recently published Global Initiative for Lung Disease guidelines have specifically stated that opioids are contraindicated in COPD management due to the potential respiratory depression and worsening hypercapnia. Nebulized opioids should be discouraged, as current data do not support their use.
authors.affiliation: Creighton University School of Pharmacy and Health Professions, 2500 California Plaza, Omaha, NE 68178, USA. pforal@creighton.edu
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Foral
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malesker
authors.forename: Guillermo
authors.initials: G
authors.lastname: Huerta
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Hilleman
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D011659:Pulmonary Gas Exchange; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D009294:Narcotics