Repeat dose opioids may be effective for breathlessness in chronic heart failure if given for long enough.
BACKGROUND
The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF).


OBJECTIVE
Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF.


METHODS
We conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo. Thirty-five participants from a tertiary cardiology clinic completed the RCT. Thirty-three were followed for 3 months, continuing open-label opioids if they wished. Thirteen participants continued an opioid; 20 did not. Four measures of breathlessness intensity (0-10 numerical rating scale [NRS] and modified Borg score, each recording worst and average breathlessness during 24 hours) were combined using principal component analysis to give a single measure for the primary analysis. Groups were compared using analysis of covariance. Secondary measures included quality of life (SF-12(®) Health Survey), cardiorespiratory, and global impression of change in breathlessness at 3 months.


RESULTS
At 3 months, the composite breathlessness measure improved to a greater extent in the opioid group (p=0.017). The opioid group had an improvement in global impression of change (mean 2.62 [opioids] versus -0.65 [nonopioids]; p=0.0009). The SF-12 physical component improved more in the opioid group (p=0.014). Cardiorespiratory variables were unchanged.


CONCLUSIONS
Opioids given for 3 months were well tolerated and safe. Opioid-related improvement in breathlessness in people with CHF might not be seen until longer-term administration. We cannot conclude from these data that they are effective and a longer-term RCT is needed.
Hull York Medical School, University of Hull, Scarborough, North Yorkshire, United Kingdom.
Stephen G
SG
Oxberry
J Martin
JM
Bland
Andrew L
AL
Clark
John G
JG
Cleland
Miriam J
MJ
Johnson
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D002908:Chronic Disease; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D010098:Oxycodone / Q000008:administration & dosage*; D010919:Placebos; D025341:Principal Component Analysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D010919:Placebos; D009020:Morphine; D010098:Oxycodone