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Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea
Open accessAbstract
Objective To determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated. Design Randomised, double blind, placebo controlled crossover study. Setting Four outpatient clinics at a hospital in South Australia. Participants 48 participants who had not previously been treated with opioids (mean age 76, SD 5) with predominantly chronic obstructive pulmonary disease (42, 88%) were randomised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo, or vice versa. Laxatives were provided as needed. Main outcome measures Dyspnoea in the morning and evening as shown on a 100 mm visual analogue scale, quality of sleep, wellbeing, performance on physical exertion, and side effects as measured at the end of the four day treatment period. Results 38 participants completed the study; three withdrew because of definite and two because of possible side effects of morphine (nausea, vomiting, and sedation). Participants reported significantly different dyspnoea scores when treated with morphine: an improvement of 6.6 mm (95% confidence interval 1.6 mm to 11.6 mm) in the morning and of 9.5 mm (3.0 mm to 16.1 mm) in the evening (P = 0.011 and P = 0.006, respectively). During the period in which they were taking morphine participants also reported better sleep (P = 0.039). More participants reported distressing constipation while taking morphine (9 v 1, P = 0.021) in spite of using laxatives. All other side effects were not significantly worse with morphine, although the study was not powered to address side effects. Conclusions Sustained release, oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting.
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“Even opioids, with most evidence to support their use, provide benefit of only borderline clinical significance.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [19]
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Metadata
- Authors
- Abernethy, A. P., Currow, D. C., Frith, P., Fazekas, B. S., McHugh, A., & Bui, C.
- Affiliations
- Flinders University (AU)
- Repatriation General Hospital (AU)
- Nepean Hospital (AU)
- Corresponding author
- Currow, David C
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2003-09-04
- Volume
- 327
- Issue
- 7414
- Pages
- 523-528
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC192892
- OpenAlex
- W2157851934
- Cited by
- 521
- References
- 26
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 17 · 2021: 20 · 2020: 22 · 2019: 19 · 2018: 38 · 2017: 34 · 2016: 38 · 2015: 44 · 2014: 26 · 2013: 25 · 2012: 40
- FWCI
- 11.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- sustained-release morphine, oral morphine, chronic obstructive pulmonary disease, opioid therapy, dyspnea, sleep quality, constipation, opioid side effects, palliative care, community-based treatment
- MeSH terms
- Administration, Oral, Aged, Chronic Disease, Delayed-Action Preparations, Double-Blind Method, Dyspnea, Female, Humans, Male, Morphine, Narcotics, Cross-Over Studies, Pulmonary Disease, Chronic Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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