144 / 671
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