title: The use of nebulized opioids in the management of dyspnea: evidence synthesis.
abstract: 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.
authors.affiliation: Cancer Institute of New Jersey, New Brunswick, NJ, USA. joycepe@umdnj.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Joyce
authors.forename: Maryellen
authors.initials: M
authors.lastname: McSweeney
authors.forename: Virginiay L
authors.initials: VL
authors.lastname: Carrieri-Kohlman
authors.forename: Josephine
authors.initials: J
authors.lastname: Hawkins
mesh_terms: 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
chemical_list: D009294:Narcotics