title: Oral transmucosal fentanyl citrate for dyspnea in terminally ill patients: an observational case series.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) in terminally ill patients experiencing dyspnea.
  
  
  METHODS
  Nonblinded, non-controlled observational study of patients admitted to the hospice/palliative care unit for dyspnea from May 2006 to March 2007. Eligible patients were older than 18 years of age with satisfactory baseline cognitive function diagnosed with end-stage congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or cancer complaining of dyspnea. At the onset of dyspnea, enrolled patients were instructed to slowly dissolve the OTFC lozenge and rate their dyspnea on a 10 point visual analog scale at 15-minute intervals for 60 minutes. Respiratory rate (RR) and arterial oxygen saturation (SaO(2)) were recorded at similar intervals. Patients were observed for approximately 48 hours.
  
  
  RESULTS
  Four patients were found eligible. In all four cases, patients experienced rapid relief of dyspnea as soon as five minutes. No significant adverse events were reported.
  
  
  CONCLUSIONS
  OTFC appears to be safe and effective for dyspnea in terminally ill patients. The study population is limited to four cases, however, the initial findings are promising and merit further research.
authors.affiliation: Department of Internal Medicine, Scranton Temple Residency Program, Scranton, PA 18510, USA.
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Gauna
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Kang
authors.forename: Mary Lawhon
authors.initials: ML
authors.lastname: Triano
authors.forename: Erica Rachel
authors.initials: ER
authors.lastname: Swatko
authors.forename: Vincent Jay
authors.initials: VJ
authors.lastname: Vanston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D010147:Pain Measurement; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011658:Pulmonary Fibrosis / Q000150:complications; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl