title: Attitudes toward opioids for refractory dyspnea in COPD among Dutch chest physicians.
abstract: Dyspnea is the most frequently reported symptom of outpatients with advanced chronic obstructive pulmonary disease (COPD). Opioids are an effective treatment for dyspnea. Nevertheless, the prescription of opioids to patients with advanced COPD seems limited. The aims of this study are to explore the attitudes of Dutch chest physicians toward prescription of opioids for refractory dyspnea to outpatients with advanced COPD and to investigate the barriers experienced by chest physicians toward opioid prescription in these patients. All chest physicians (n = 492) and residents in respiratory medicine (n = 158) in the Netherlands were invited by e-mail to complete an online survey. A total of 146 physicians (response rate 22.5%) completed the online survey. Fifty percent of the physicians reported to prescribe opioids for refractory dyspnea in 20% or less of their outpatients with advanced COPD and 18.5% reported never to prescribe opioids in these patients. The most frequently reported barriers toward prescription of opioids were resistance of the patient, fear of possible adverse effects, and fear of respiratory depression. To conclude, Dutch chest physicians and residents in respiratory medicine rarely prescribe opioids for refractory dyspnea to outpatients with advanced COPD. This reluctance is caused by perceived resistance of the patient and fear of adverse effects, including respiratory adverse effects.
authors: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands daisyjanssen@ciro-horn.nl.
authors: Daisy J A
authors: DJ
authors: Janssen
authors: Wilhelmina Hospital, Assen, The Netherlands.
authors: S M
authors: SM
authors: de Hosson
authors: Merem Asthma Center Heideheuvel, Hilversum, The Netherlands.
authors: Eline
authors: E
authors: bij de Vaate
authors: Kennemer Gasthuis, Haarlem, The Netherlands.
authors: Kris J M
authors: KJ
authors: Mooren
authors: Hospital Rivierenland, Tiel, The Netherlands.
authors: Albert A F
authors: AA
authors: Baas
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000379:methods*; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*
chemical_list: D000701:Analgesics, Opioid
keywords: Opioids; breathlessness; morphine; palliative care; symptoms