Low-Dose Morphine for Dyspnea in Terminally Ill Patients with Idiopathic Interstitial Pneumonias

Background: Dyspnea is highly prevalent in patients with idiopathic interstitial pneumonias (IIPs). Objective: The objective of this study is to examine the effectiveness and safety of continuous subcutaneous morphine for dyspnea in terminally ill IIP patients. Setting/Subjects: We retrospectively reviewed cases of terminally ill IIP patients who received continuous subcutaneous morphine for dyspnea. Measurements: We reviewed dyspnea severity measured using numerical rating scale (NRS) and respiratory rate (RR) before and two and four hours after morphine initiation. We conducted subgroup analyses of patients with and without noninvasive positive pressure ventilation (NPPV). Results: Twenty-five patients were included in this study. Median morphine dose at morphine initiation and two and four hours after treatment was 0.25, 0.25, and 0.5mg/hour, respectively. Dyspnea NRS decreased significantly four hours after (meanstandard deviation: 5.32 +/- 2.58, p=0.04) but not two hours (5.52 +/- 2.43, p=0.11) after morphine initiation compared with baseline (7.08 +/- 2.33). RR did not change significantly either two or four hours after treatment compared with baseline. The median survival after morphine initiation was 47 hours. Patients who were not using NPPV showed significantly improved dyspnea both two and four hours after treatment compared with baseline, although patients who used NPPV showed no significant improvement with morphine. RR did not significantly change in either subgroup. Conclusions: Morphine might improve dyspnea in terminally ill IIP patients without decrease in RR.