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Prescription of opioids for breathlessness in end-stage COPD : A national population-based study

Ahmadi, Zainab LU ; Bernelid, Eva; Currow, David C and Ekström, Magnus LU (2016) In International Journal of COPD 11(1). p.2651-2657
Abstract

Background: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. Objectives: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. Methods: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed... (More)

Background: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. Objectives: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. Methods: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed quantity, date of dispensing, and indications categorized as pain, breathlessness, other, or unknown. Results: In total, 2,249 COPD patients (59% women) were included. During a median follow-up of 1.1 (interquartile range 0.6–2.0) years, 1,034 patients (46%) were dispensed ≥1 opioid prescription (N=13,722 prescriptions). The most frequently prescribed opioids were tramadol (23%), oxycodone (23%), morphine (16%), and codeine (16%). Average dispensed quantity was 9.3 (interquartile range 3.7–16.7) defined daily doses per prescription. In the random sample, the most commonly stated indication was pain (97%), with only 2% for breathlessness and 1% for other reasons. Conclusion: Despite evidence that supported the use of opioids for the relief of breathlessness predating this study, opioids are rarely prescribed to relieve breathlessness in oxygen-dependent COPD, potentially contributing to less-than-optimal symptom control. This study creates a baseline against which to compare future changes in morphine prescribing in this setting.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breathlessness, COPD, LTOT, Opioids, Prescriptions, Symptoms
in
International Journal of COPD
volume
11
issue
1
pages
7 pages
publisher
Dove Press
external identifiers
  • scopus:85015994874
  • wos:000386227400003
ISSN
1176-9106
DOI
10.2147/COPD.S112484
language
English
LU publication?
yes
id
0d436a0d-1be8-486c-9bd9-db22c24374dd
date added to LUP
2017-04-19 14:45:33
date last changed
2017-11-19 04:39:23
@article{0d436a0d-1be8-486c-9bd9-db22c24374dd,
  abstract     = {<p>Background: Low-dose opioids can relieve breathlessness but may be underused in late-stage COPD due to fear of complications, contributing to poor symptom control. Objectives: We aimed to study the period prevalence and indications of opioids actually prescribed in people with end-stage COPD. Methods: The study was a longitudinal, population-based study of patients starting long-term oxygen therapy (LTOT) for COPD between October 1, 2005 and June 30, 2009 in Sweden. A random sample (n=2,000) of their dispensed opioid prescriptions was obtained from the national Prescribed Drugs Register from 91 days before starting LTOT until the first of LTOT withdrawal, death, or study end (December 31, 2009). We analyzed medication type, dispensed quantity, date of dispensing, and indications categorized as pain, breathlessness, other, or unknown. Results: In total, 2,249 COPD patients (59% women) were included. During a median follow-up of 1.1 (interquartile range 0.6–2.0) years, 1,034 patients (46%) were dispensed ≥1 opioid prescription (N=13,722 prescriptions). The most frequently prescribed opioids were tramadol (23%), oxycodone (23%), morphine (16%), and codeine (16%). Average dispensed quantity was 9.3 (interquartile range 3.7–16.7) defined daily doses per prescription. In the random sample, the most commonly stated indication was pain (97%), with only 2% for breathlessness and 1% for other reasons. Conclusion: Despite evidence that supported the use of opioids for the relief of breathlessness predating this study, opioids are rarely prescribed to relieve breathlessness in oxygen-dependent COPD, potentially contributing to less-than-optimal symptom control. This study creates a baseline against which to compare future changes in morphine prescribing in this setting.</p>},
  author       = {Ahmadi, Zainab and Bernelid, Eva and Currow, David C and Ekström, Magnus},
  issn         = {1176-9106},
  keyword      = {Breathlessness,COPD,LTOT,Opioids,Prescriptions,Symptoms},
  language     = {eng},
  month        = {10},
  number       = {1},
  pages        = {2651--2657},
  publisher    = {Dove Press},
  series       = {International Journal of COPD},
  title        = {Prescription of opioids for breathlessness in end-stage COPD : A national population-based study},
  url          = {http://dx.doi.org/10.2147/COPD.S112484},
  volume       = {11},
  year         = {2016},
}