title: Prescription of opioids for breathlessness in end-stage COPD: a national population-based study.
abstract: BACKGROUND
  Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control.
  
  
  OBJECTIVE
  We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD.
  
  
  METHODS
  The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed quantity, date of dispensing, and indications categorized as pain, breathlessness, other, or unknown.
  
  
  RESULTS
  In total, 2,249 COPD patients (59% women) were included. During a median follow-up of 1.1 (interquartile range 0.6-2.0) years, 1,034 patients (46%) were dispensed ≥1 opioid prescription (N=13,722 prescriptions). The most frequently prescribed opioids were tramadol (23%), oxycodone (23%), morphine (16%), and codeine (16%). Average dispensed quantity was 9.3 (interquartile range 3.7-16.7) defined daily doses per prescription. In the random sample, the most commonly stated indication was pain (97%), with only 2% for breathlessness and 1% for other reasons.
  
  
  CONCLUSIONS
  Despite evidence that supported the use of opioids for the relief of breathlessness predating this study, opioids are rarely prescribed to relieve breathlessness in oxygen-dependent COPD, potentially contributing to less-than-optimal symptom control. This study creates a baseline against which to compare future changes in morphine prescribing in this setting.
authors: Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University Hospital, Lund; Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
authors: Zainab
authors: Z
authors: Ahmadi
authors: Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
authors: Eva
authors: E
authors: Bernelid
authors: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.
authors: David C
authors: DC
authors: Currow
authors: Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University Hospital, Lund; Department of Medicine, Blekinge Hospital, Karlskrona, Sweden; Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.
authors: Magnus
authors: M
authors: Ekström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D004417:Dyspnea / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: COPD; LTOT; breathlessness; opioids; prescriptions; symptoms