• Stephen G Oxberry, J Martin Bland, Andrew L Clark, John G Cleland, and Miriam J Johnson.
• Hull York Medical School, University of Hull, Scarborough, North Yorkshire, United Kingdom.
• J Palliat Med. 2013 Mar 1;16(3):250-5.

BackgroundThe longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF).ObjectiveOur aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF.MethodsWe conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo. Thirty-five participants from a tertiary cardiology clinic completed the RCT. Thirty-three were followed for 3 months, continuing open-label opioids if they wished. Thirteen participants continued an opioid; 20 did not. Four measures of breathlessness intensity (0-10 numerical rating scale [NRS] and modified Borg score, each recording worst and average breathlessness during 24 hours) were combined using principal component analysis to give a single measure for the primary analysis. Groups were compared using analysis of covariance. Secondary measures included quality of life (SF-12(®) Health Survey), cardiorespiratory, and global impression of change in breathlessness at 3 months.ResultsAt 3 months, the composite breathlessness measure improved to a greater extent in the opioid group (p=0.017). The opioid group had an improvement in global impression of change (mean 2.62 [opioids] versus -0.65 [nonopioids]; p=0.0009). The SF-12 physical component improved more in the opioid group (p=0.014). Cardiorespiratory variables were unchanged.ConclusionsOpioids given for 3 months were well tolerated and safe. Opioid-related improvement in breathlessness in people with CHF might not be seen until longer-term administration. We cannot conclude from these data that they are effective and a longer-term RCT is needed.

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