title: Inhaled morphine for palliation of dyspnea in end-stage cystic fibrosis.
abstract: OBJECTIVE
  The successful use of inhaled morphine to relieve dyspnea in a patient with end-stage cystic fibrosis (CF) lung disease is described.
  
  
  CONCLUSIONS
  A 48-year-old man with CF was hospitalized for a pulmonary exacerbation caused by infection with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). His medical history included long-standing depression, chronic pain, spinal stenosis, benign prostatic hypertrophy, iron-deficiency anemia, and colectomy. Over the two previous years, his chronic pain had progressively worsened, and he had developed narcotic dependency. The etiology of his pain was unclear. During this time, his pulmonary status had slowly deteriorated due to chronic infection with P. aeruginosa and MRSA. As his lung function had deteriorated, he and his family had declined consideration for lung transplantation and requested no heroic interventions when death was imminent. His medications at time of admission included supplemental oxygen, dornase alfa, ipratropium bromide, and albuterol. The opioids used by the patient at the time of admission included oral methadone, oral oxycodone, transdermal fentanyl, and oral morphine sulfate. Upon admission with this pulmonary exacerbation, the patient was started on antibiotics. His pain was eventually controlled with i.v. methadone and ketamine, but his dyspnea continued. Inhaled morphine sulfate 2 mg in 5 mL of 0.9% sodium chloride injection was started and administered every four hours. Clinically significant improvements in the patient's dyspnea, measured using a modified Borg score, were observed with subsequent doses. His dyspnea remained well controlled until his death two days later.
  
  
  CONCLUSIONS
  Inhaled morphine was effective in relieving dyspnea in a patient with end-stage CF lung disease.
authors.affiliation: Departments of Pediatrics and Internal Medicine, College of Medicine, University of Kentucky, J410 Kentucky Clinic, 740 South Limestone Street, Lexington, KY 40536, USA. don.hayes@uky.edu
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.forename: Michael I
authors.initials: MI
authors.lastname: Anstead
authors.forename: Rena T
authors.initials: RT
authors.lastname: Warner
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kuhn
authors.forename: Hubert O
authors.initials: HO
authors.lastname: Ballard
mesh_terms: D000280:Administration, Inhalation; D003550:Cystic Fibrosis / Q000150:complications*; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000494:pharmacology*; D009294:Narcotics / Q000008:administration & dosage* / Q000494:pharmacology; D017063:Outcome Assessment, Health Care; D011552:Pseudomonas Infections / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications; D019452:Terminally Ill
chemical_list: D009294:Narcotics; D009020:Morphine