Narcotics for Distressful Breathing

A Review of Different Studies Ekstrom and colleagues reviewed the effects of narcotics on relief of distressful breathing and exercise ability in the March 24, 2015, issue of the Annals of the American Thoracic Society. Based on the results of 8 studies involving those with COPD, narcotic medications (usually morphine) given as a pill or by a shot (injection) reduced the severity of breathing difficulty. The benefit of narcotic medications given as a solution in a nebulizer was considered to be “low.” Narcotic medications had no effect on the exercise ability of the patients with COPD (13 studies). Comment: Narcotic medications are used routinely for reducing pain. This review confirms that narcotic medications, mainly morphine, are effectively for reducing breathing difficulty. Usually, narcotics are used when breathing difficulty becomes persistent and distressful despite use of the best available treatment for COPD. This includes inhaled bronchodilators, possible use of an inhaled corticosteroid, oxygen if indicated, and pulmonary rehabilitation if appropriate. Before a trial of morphine, your doctor should discuss the goals of using morphine as well as possible side effects of the medication. Side effects may include drowsiness, sleepiness, nausea, upset stomach, and constipation.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.