BMJ  2003;327:1288 (29 November), doi:10.1136/bmj.327.7426.1288-b

Letter

Morphine for management of refractory dyspnoea

Opiates should be used with caution

The first 150 words of the full text of this article appear below.

EDITOR—Abernethy et al identify that hypercapnia and respiratory depression are impediments to the use of opiates in patients with chronic obstructive pulmonary disease, yet they do little to allay those concerns in their report.1

Most (88%) of their patients were reported to have chronic obstructive pulmonary disease. This is a diagnosis based on spirometric assessment,2 but they present no such data. Spirometry would give confirmation of the diagnosis, prognostic information and perhaps selection criteria for the intervention. We disagree that measurement of pulmonary function would be neither generalisable nor ethical as spirometry is an easily performed, non-invasive procedure that is widely available.

The authors say that no respiratory depression was identified, but they present no data to support this. Oxygen saturation and respiratory rate, which are reported, may not identify respiratory depression. Alveolar hypoventilation, the result of respiratory depression, is a function of respiratory rate and tidal volume. . . . [Full text of this article]

James W Berrill, house officer, medicine

James_w_berrill@hotmail.com

Seamus J Linnasne, consultant respiratory physician

Llandough Hospital, Penarth, Cardiff CF64 2XX


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Relevant Article

Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea
Amy P Abernethy, David C Currow, Peter Frith, Belinda S Fazekas, Annie McHugh, and Chuong Bui
BMJ 2003 327: 523-528. [Abstract] [Full Text] [PDF]

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