[Symptomatic treatment of dyspnoea in patients receiving palliative care: nasal delivery of oxygen compared with opioid administration].
OBJECTIVE
Dyspnoea frequently occurs in patients with advanced tumor disease receiving palliative care (prevalence > 50). Aim of the study was to assess, in dyspneic patients in palliative care, the efficacy of opioids in treating their dyspnoea and to determine whether or not nasal administration of oxygen previous to opioid administration would decrease the severity of dyspnoea.


METHODS
In a prospective, non-randomised study 25 patients with cancer who had been admitted to our palliative care unit were investigated (aged 64.5 +/- 15.1 [40-90] years; 11 males [44 %]. 13 patients reported severe and 12 moderate dyspnoea. For symptomatic treatment of dyspnoea, 12 patients received morphine and 13 patients hydromorphine. The severity of of dyspnoea was rated according to a numeric scale (NRS 0-10). Recorded and compared was severity of dyspnoea at admission before any oxygen had been administered, after 30 minutes of nasal oxygen, and 30, 60, 90 and 120 minutes after the first administration of opioid without nasal oxygen.


RESULTS
Whereas there was no change in the severity of dyspnoea during nasal oxygen administration, mean respiratory rate (f) 30 minutes after the first opioid application had significantly decreased. The intensity of dyspnoea had significantly diminished 90 minutes after the first opioid application.


CONCLUSIONS
During nasal oxygen administration the severity of dyspnoea, as measured by use of NRS had not decreased, whereas it had significantly decreased after the first opioid administration.
Clemens
K E
KE
Lehr- und Forschungsstelle, Zentrum für Palliativmedizin, Universität Bonn, Germany. katri-elina.clemens@malteser.de
Klaschik
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D012720:Severity of Illness Index
D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone