Reduction in Opioids for Pain: Could This Make My Breathing Worse?

Reduction in Opioids and Breathing is Worse

Dear Dr. Mahler:

I have COPD-my Dr. has taken me completely off the Fentanyl patch which I used for years – I have several issues that cause me a lot of pain. I have also been on Vicodin – 8 each day. They are now cutting back on it.
My problem is my breathing has worsened and I have had increased breathing exacerbations with these cut backs. Do you think there could be a connection?
Do you have any suggestions for me? Between the pain and breathing issues my quality of life is bad and I am depressed that I can’t do the things I used to. I use the Stiolto Respimat and Albulterol when I have a bad breathing situation.
Would really appreciate if you would have any suggestions for me. THANK YOU.

Sandra from Little Rock, AK

Dear Sandra:

Your experience is not unusual.

opium poppy is source of natural opiods

Opium poppy

Both fentanyl and vicodin are opioids that act on receptors in the body to relieve pain. Opioids include opiates that found in the resin of the opium poppy (incluidng morphine) as well as medications made in laboratories that are called synthetic drugs. These include fentanyl and vicodin [hydrocodone and acetaminophin (brand name is tylenol)] which you are or were taking.

Opioids are also helpful to relieve shortness of breath. Usually, they are used for those with advanced disease for palliation. It is quite possible that your worsening in breathing is related to the reduction in opioids. Remember that opioids may cause side effects including tiredness, low energy, sleepiness, and constipation.

water exercise may help shortness of breath due to reduction in opioids

Seniors doing Water Aerobics

exercise may help with shortness of breath due to reduction in opioids

Man pedaling stationary cycle being supervised by rehabilitation specialist.

Could the combination of your COPD and use of fentanyl/vicodin led to an inactive life style? If so, is it possible for you to do more activities to improve your breathing, or does your pain limit activity level? Is participation in a pulmonary rehabilitation program a possibility for you? Are water activities possible with your pain problem?

Another question that I have relates to your report of exacerbations with reduction in opioids. Are you experiencing chest congestion and coughing up yellow or green mucus with these episodes? If so, I suggest that you ask your doctor to check for bronchiectasis (see post on April 21, 2017, under COPD News) and acquired immunodeficiency (see post on November 23, 2016, under COPD News). Both of these conditions may lead to frequent flare-ups.

Finally, you may wish to ask your doctor about starting an inhaled corticosteroid medication to help reduce the risk of future flare-ups. Your current use of Stiolto Respimat as a maintenance medication is excellent as it contains two different types of long-acting bronchodilators. The 2017 GOLD recommendations suggest that an inhaled cortiosteroid be added to a medication like Stiolto if you continue to experience exacerbations.

I hope this information is helpful. Best wishes,

Donald A. Mahler, M.D.

Water Exercise

Dear Dr. Mahler:

I recently took an aquatic session (mild exercise) which i found very helpful in getting good exercise.  I stayed close to the deck and  had my  oxygen on the side of the pool.  This setup worked well with the class. Fortunately the class was attended by several nurses from one  of our hospitals (did not need their services.)  I am a good swimmer, but it very hard when attached to oxygen tube.  I think I will take another class early this fall if offered.  What do you think of this exercise?

Sally from Lansing, MI

Dear Sally,

I am glad to hear that you enjoyed the water exercise program, and I congratulate you on doing this while using oxygen. Your example may help others be more active.

Although actual swimming may be quite challenging for anyone, especially someone with COPD, upright exercise in water is considered safe. In fact, water exercises are a great alternative to land based activities which may difficult for those with arthritis, pain problems, or are overweight.

sm00055-water-walking-with-hand-webs

Standing in water is called immersion and creates pressure on the abdomen (stomach area) and chest. The higher the water level is relative to the chest (see photos), the greater the outward pressure on the chest and the harder the lungs must work. Over time, this extra work by the diaphragm and other breathing muscles will increase their strength and endurance.

Before someone with COPD starts an exercise program in water, make sure that the water temperature is warm and comfortable. Use albuterol or other short-acting bronchodilators 15 minutes before you enter the pool. I suggest that the person stand in water up to the waist to get used to the experience. You might walk back and forth in the pool to warm up and see what it feels like. Then, you can try going into deeper water and note if there is any change in your breathing. You can always move into shallower water if breathing becomes too difficult.

For those that require oxygen, the oxygen tank should be stabilized on the pool deck along with long (40 inch) tubing that can provide some flexibility for movement. Whether you participate in a water aerobics class depends on your interest and motivation. Many men and women who exercise in a pool report that they love the experience and appreciate the benefits of the buoyancy of the water.

I hope that this information is helpful for you, and I encourage you to enroll in the fall class.

Sincerely,

Donald A. Mahler, M.D.