The use of nebulized opioids in the management of dyspnea: evidence synthesis.
OBJECTIVE
To analyze the evidence about the use of nebulized opioids to treat dyspnea using the Priority Symptom Management (PRISM) level-of-evidence framework and to make a practice recommendation.


METHODS
Computerized database and manual search for articles and abstracts that included experimental trials, chart reviews, and case studies.


RESULTS
20 articles with evaluable evidence were identified. Analysis was complex because of heterogeneous variables and outcome measures. A major limitation is small sample sizes. The majority of PRISM level I and II studies indicated unfavorable evidence.


CONCLUSIONS
Scientific data supporting the use of nebulized opioids to treat dyspnea in patients with chronic pulmonary disease, including malignancy, are lacking.


CONCLUSIONS
Insufficient data identify a need for further research with random crossover designs involving larger samples that are stratified according to prior opioid use. Consistency of study variables should be emphasized.
Joyce
Margaret
M
Cancer Institute of New Jersey, New Brunswick, NJ, USA. joycepe@umdnj.edu
McSweeney
Maryellen
M
Carrieri-Kohlman
Virginiay L
VL
Hawkins
Josephine
J
D000280:Administration, Inhalation; D002318:Cardiovascular Diseases / Q000150:complications; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology / Q000451:nursing*; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D009294:Narcotics / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers
D009294:Narcotics