TOPLINE

In patients with stable chronic obstructive pulmonary disease (COPD) and persistent breathlessness, low-dose transdermal fentanyl and low-dose sustained-release oral morphine did not reduce daily breathlessness or improve related outcomes compared with placebo.

METHODOLOGY

• Researchers conducted a randomized double-blind crossover trial across 10 hospitals in the Netherlands to assess whether low-dose transdermal fentanyl or sustained-release oral morphine reduced persistent dyspnea in patients with stable COPD.
• A total of 58 participants with stable COPD and persistent dyspnea despite optimal care were enrolled between 2019 and 2024. The mean age of patients was 69 years, 54% were women, and mean forced expiratory volume in 1 second was 33% predicted.
• Each patient received transdermal fentanyl (12 µg/h), sustained-release oral morphine (10 mg twice daily), and placebo in random order, each for 11 days with a 3-day washout between periods.
• The primary outcome was a change in mean daily breathlessness measured on a scale of 0-10. Secondary outcomes included worst daily dyspnea, health status, anxiety, sleep quality, and capillary blood gas parameters.

TAKEAWAY

• A total of 37 patients completed all three treatment periods. Discontinuations mainly occurred because of COPD exacerbations and side effects.
• No significant differences between fentanyl or morphine and placebo for mean daily dyspnea, worst dyspnea, sleep quality, health status, capillary partial pressure of carbon dioxide, or anxiety.
• Vomiting occurred in five patients during morphine treatment, while other side effects did not differ clearly between treatments.

IN PRACTICE

"We advocate a focus on a multimodal approach including non-pharmacological interventions as a more promising avenue to investigate for alleviating dyspnea in this patient population," the authors of the study wrote.

SOURCE

The study was led by Marlies van Dijk, University Medical Center Groningen, Groningen, Netherlands. It was published online on August 6 in the European Respiratory Journal.

LIMITATIONS

The study was slightly underpowered owing to a higher dropout rate than anticipated. Missing data may have biased the analysis. The study was not powered for a direct comparison between fentanyl and morphine.

DISCLOSURES

The study was supported by grants from Stichting Astma Bestrijding, Innovatiefonds Zorgverzekeraars, and University Medical Center Groningen. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.