1.Introduction

The approach for chronic refractory breathlessness is not

different from that of opioid treatment for refractory pain

Sustained release morphine should be a first line treatment

and should be initiated at a low dose and titrated upward

over days and weeks, balancing beneficial and adverse

effects.

Titration

up to 30 mg morphine/d

might safely improve

breathlessness in > 60% of patients, with a mean decrease

of 35% in the intensity of breathlessness from the person’s

own baseline.

Safety of benzodiazepines and opioids in very severe respiratory

disease: national prospective study

BMJ 2014;348:g445

M Ekström, Department of Medicine, Blekinge Hospital, SE-37185, Karlskrona,

Sweden

pmekstrom@gmail.com