title: Acceptability and preferences of six different routes of drug application for acute breathlessness: a comparison study between the United Kingdom and Germany.
abstract: BACKGROUND
  Opioids are the drugs of choice for management of breathlessness in advanced disease, but acute episodic breathlessness remains difficult to manage. New routes of opioid applications with quicker onset of action seem attractive for the management of episodic breathlessness.
  
  
  OBJECTIVE
  This study aimed to determine the acceptability and preference of different routes of opioid applications in patients suffering from breathlessness due to advanced disease.
  
  
  METHODS
  The study consisted of structured face-to-face interviews with patients suffering from breathlessness due to lung cancer (LC), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and motor neurone disease (MND). Images and explanation were used to illustrate six application forms (oral, inhaled, sublingual, intranasal, buccal, transmucosal).
  
  
  RESULTS
  Participants numbered 119 (UK n=48, Germany n=71), 60% male, mean age 67.7 years (SD 9.9); 50% suffered from COPD. Inhaled was the most accepted (87%) and preferred (68%) route of application, followed by sublingual (45%/13%) and intranasal (42%/8%). The oral was least accepted (24%) and least preferred (9%) although nearly all participants had previous experiences with it (97%). Ratings were similar in both countries but different for preferences of sublingual (UK>Germany) and intranasal (Germany>UK). In general, participants from the UK rated more often "yes" for acceptability of all routes compared to Germany.
  
  
  CONCLUSIONS
  Inhaled was the most accepted and preferred route of application, but no route seemed to be acceptable to all patients. Therefore, individual patient preferences should be explored before drug prescription to enhance compliance and convenience.
authors.affiliation: Department of Palliative Medicine and Clinical Trials Unit, University Hospital Cologne, Cologne, Germany. steffen@steffensimon.de
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Niemand
authors.forename: Hamid
authors.initials: H
authors.lastname: Benalia
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004333:Drug Administration Routes; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000150:complications; D010166:Palliative Care; D057240:Patient Preference; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D036301:Qualitative Research; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid