Morphine Could Improve Breathlessness in COPD Patients

The use of low-dose, sustained-release morphine could improve disease-specific health status in patients with moderate to very severe chronic breathlessness due to chronic obstructive pulmonary disease (COPD) without increasing the risk of adverse effects, according to the results of a recent study.

The findings are the result of a randomized, double-blind, and placebo-controlled study, Morphine for Treatment of Dyspnea in Patients with COPD (MORDYC), which was conducted between November 2016 and January 2019 with a total of 111 participants.

The participants were randomly assigned to either 10 mg of morphine or placebo twice daily for the duration of the 4-week study period. The primary outcomes were the participants’ COPD Assessment Test (CAT) scores (higher scores represented worse health status) and arterial partial pressure of carbon dioxide (Paco2). Breathlessness in the previous 24 hours as a numeric rating scale was included in their measurements as a secondary outcome. Of the participants who were between grades 3 and 4 in the modified Medical Research Council (mMRC), additional analyses were completed.

The researchers observed a CAT score that was lower by 2.18 points in the morphine group (95% CI, (-4.14) – (-0.22)) compared with the placebo group. Paco2  was 1.19 mm Hg higher in the morphine group compared with the placebo group (95% CI, –2.70 to 5.07 mm Hg; P = .55). Overall, 5 of the 54 patients in the morphine group and 1 of the 57 in the placebo group withdrew due to adverse effects.

“In this randomized clinical trial, regular, low-dose, oral sustained-release morphine for 4 weeks improved disease-specific health status in patients with COPD without affecting Paco2 or causing serious adverse effects. The worst breathlessness improved in participants with mMRC grades 3 to 4. A larger randomized clinical trial with longer follow-up in patients with mMRC grades 3 to 4 is warranted,” the study authors concluded.

—Leigh Precopio

Reference:

Verberkt CA, van den Beuken-van Everdingen MH, SChols JMGA, Hameleers N, Wouters EFM, and Janssen DJA. Effect of sustained-release morphine for refractory breathlessness in chronic obstructive pulmonary disease on health status. JAMA Int Med. 2020;180(10):1306-1314/. doi: 10.1001/jamainternmed.2020.3134