title: Low dose diamorphine reduces breathlessness without causing a fall in oxygen saturation in elderly patients with end-stage idiopathic pulmonary fibrosis.
abstract: There is very little evidence regarding the safety and efficacy of opioids for the control of dyspnoea in the terminal stages of idiopathic pulmonary fibrosis (IPF). We conducted an open case series study of 11 elderly opioid-naive patients referred for management of severe breathlessness before and after their first injection of 2.5 mg diamorphine subcutaneously. Subjective breathlessness, measured by a 100 mm visual analogue scale, fell by a mean of 47 mm in the first 15 min (P < 0.0001) and the mean heart rate fell by 12/min (P = 0.007). There were small non-significant falls in the mean respiratory rate (2/min), systolic blood pressure (6 mmHg) and oxygen saturation (1%). These changes were maintained at 30 min. Follow up treatment with oral morphine remained effective in reducing the symptom of breathlessness and no patient showed signs of respiratory depression. Low dose opioids are effective and safe in the palliative management of IPF in frail elderly patients.
authors.affiliation: The Royal Bournemouth and Christchurch Hospitals NHS trust, Castle Lane East, Bournemouth, BH7 7DW, UK. stephen.allen@rbch-tr.swest.nhs.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Allen
authors.forename: Satru
authors.initials: S
authors.lastname: Raut
authors.forename: Jane
authors.initials: J
authors.lastname: Woollard
authors.forename: Michael
authors.initials: M
authors.lastname: Vassallo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004417:Dyspnea / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D011658:Pulmonary Fibrosis / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine