title: Nebulized morphine for intractable cough in advanced cancer: two case reports.
abstract: BACKGROUND
  Cough is a distressing symptom in advanced cancer. Opioids are used to relieve respiratory symptoms including dyspnea and cough. In addition to a central mechanism, opioids are thought to work peripherally via opioid receptors of the lung. Therefore, direct inhalation of morphine has been investigated in chronic lung disease or cancer. We report our experience of a nebulized form of morphine to control intractable cough in patients with advanced cancer.
  
  
  RESULTS
  Case 1 is a 63-year-old female with terminal lung cancer complaining of a severe dry cough with dyspnea and sleeplessness. Case 2 is a 53-year-old female with thymic carcinoma with multiple lung metastases suffering from severe cough accompanying chest pain and dyspnea. With usual treatment, cough did not improve in these patients. We then administered a nebulized form of morphine: hydrochloro-morphine 5 mg mixed with 3 mL normal saline inhaled by mouth using a nebulizer. When the morphine dose was increased to 10 mg and 15 mg, the patients' cough was relieved to a symptom level of moderate and mild, respectively. Without experiencing any severe systemic side effects of opioids, the patients continued nebulized morphine until death or discharge.
  
  
  CONCLUSIONS
  Nebulized morphine was effective in controlling intractable cough due to cancer and it was convenient and safe.
authors: 1 Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea , Suwon, Korea.
authors: Ho Jung
authors: HJ
authors: An
authors: Il-Kyu
authors: IK
authors: Kim
authors: Jung Eun
authors: JE
authors: Lee
authors: Yi-Jin
authors: YJ
authors: Kang
authors: Chi Hong
authors: CH
authors: Kim
authors: Hoon-Kyo
authors: HK
authors: Kim
mesh_terms: D000280:Administration, Inhalation; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003371:Cough / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D013953:Thymus Neoplasms / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine