Use of opioids for refractory dyspnoea in hospitalised patients with serious illness: a narrative review

Refractory dyspnoea can be a challenging symptom to manage. Palliative care specialists are not always available for consultation, and while many clinicians may undergo training in palliative care, this education is not universal. Opioids are the most studied and prescribed pharmacological intervention for refractory dyspnoea; however, many clinicians hesitate to prescribe opioids due to regulatory concerns and fear of adverse effects. Current evidence suggests that rates of severe adverse effects, including respiratory depression and hypotension, are low when opioids are administered for refractory dyspnoea. Therefore, systemic, short-acting opioids are a recommended and safe option for the palliation of refractory dyspnoea in patients with serious illness, especially in a hospital setting that facilitates close observation. In this narrative review, we discuss the pathophysiology of dyspnoea; facilitate an evidence-based discussion on the concerns, considerations and complications associated with opioid administration for refractory dyspnoea; and describe one approach to managing refractory dyspnoea.

Automated summary

Refractory dyspnoea is a challenging symptom, and access to palliative care specialists may be limited. Opioids are a safe and recommended pharmacological intervention, despite concerns about regulation and adverse effects. Current evidence suggests low rates of severe adverse effects when opioids are used for refractory dyspnoea, making them a valuable option for palliation, particularly in a hospital setting.