title: Morphine versus midazolam as upfront therapy to control dyspnea perception in cancer patients while its underlying cause is sought or treated.
abstract: BACKGROUND
  Cancer patients with dyspnea may be able to have the symptom pharmacologically controlled while its underlying cause is sought or treated.
  
  
  OBJECTIVE
  This study was done to determine whether symptom control can be achieved while the cause is evaluated or treated and whether morphine or midazolam would be more suitable in this setting.
  
  
  METHODS
  Sixty-three ambulatory patients with advanced cancer and dyspnea were clinically characterized and then randomized to receive either oral morphine or oral midazolam. A fast in-clinic drug titration scheme was implemented followed by an ambulatory five-day period in which the patients received the effective dose that relieved their dyspnea. During this period, the patients were followed daily while the underlying causes of dyspnea were sought out or treated.
  
  
  RESULTS
  Thirty-one patients with dyspnea entered the morphine arm and 32 patients entered the midazolam one. During the initial in-clinic phase, dyspnea was alleviated by at least 50% in all patients, whether they received morphine or midazolam. During the ambulatory phase, midazolam was superior to morphine in controlling baseline and breakthrough dyspnea. Both treatments were well tolerated, with mild somnolence being the most common adverse event. Neither morphine nor midazolam affected the outcome and/or implementation of additional diagnostic and/or therapeutic interventions.
  
  
  CONCLUSIONS
  Our results suggest that cancer-related dyspnea in ambulatory patients can be pharmacologically treated while its most probable specific cause is sought and/or while an etiology-oriented intervention is implemented. In this setting, midazolam appeared to be a better option than morphine for the immediate and long-term relief of the symptom.
authors.affiliation: Internal Medicine Department, Instituto Angel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Alfredo H
authors.initials: AH
authors.lastname: Navigante
authors.forename: Monica A
authors.initials: MA
authors.lastname: Castro
authors.forename: Leandro C
authors.initials: LC
authors.lastname: Cerchietti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications; D018579:Patient Selection; D010465:Perception / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D009020:Morphine; D008874:Midazolam