Using laboratory models to test treatment: Morphine reduces dyspnea and hypercapnic ventilatory response

American Journal of Respiratory and Critical Care Medicine

Volumn 184, Issue 8, 2011, Pages 920-927

  Banzett, Robert B ^a,b   Adams, Lewis ^a,c   O'Donnell, Carl R ^a,b   Gilman, Sean A ^a,b   Lansing, Robert W ^a   Schwartzstein, Richard M ^a,b  

^a BETH ISRAEL DEACONESS MEDICAL CENTER   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c GRIFFITH UNIVERSITY   (Australia)

Author keywords

Breathlessness; Opioids; Pain; Respiratory; Signs and symptoms

Indexed keywords

MORPHINE SULFATE; PLACEBO;

ADULT; ANXIETY; ARTICLE; BREATHING DISCOMFORT VISUAL ANALOG SCALE; CLINICAL ASSESSMENT TOOL; CONCENTRATION LOSS; CONTROLLED STUDY; DIZZINESS; DOUBLE BLIND PROCEDURE; DRUG DOSE COMPARISON; DRUG MEGADOSE; DRUG SCREENING; DRUG WITHDRAWAL; DYSPNEA; END TIDAL CARBON DIOXIDE TENSION; FATIGUE; FEMALE; HUMAN; HYPERCAPNIA; HYPERCAPNIC VENTILATORY RESPONSE; MALE; NAUSEA; NORMAL HUMAN; OPIOID INDUCED EMESIS; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; SKIN TINGLING; URINE RETENTION; XEROSTOMIA;

ADULT; ANALGESICS, OPIOID; DOUBLE-BLIND METHOD; DYSPNEA; FEMALE; HUMANS; HYPERCAPNIA; MALE; MIDDLE AGED; MORPHINE; PULMONARY VENTILATION;

EID: 80054696223     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201101-0005OC     Document Type: Article

References (58)

1. O'Driscoll M, Corner J, Bailey C. The experience of breathlessness in lung cancer. Eur J Cancer Care (Engl) 1999;8:37-43.
2. Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol 2002;3:223-228. (Pubitemid 34436658)
3. Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol 2008;26:2396-2404.
4. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, Mor V. Family perspectives on end-of-life care at the last place of care. JAMA 2004;291:88-93. (Pubitemid 38040539)
5. Cuthbertson BH, Hull A, Strachan M, Scott J. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004;30:450-455. (Pubitemid 38375620)
6. Schelling G. Effects of stress hormones on traumatic memory formation and the development of posttraumatic stress disorder in critically ill patients. Neurobiol Learn Mem 2002;78:596-609. (Pubitemid 36268681)
7. Booth S, Moosavi SH, Higginson IJ. The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy. Nat Clin Pract Oncol 2008;5:90-100. (Pubitemid 351188930)
8. Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev [serial on the Internet]. 2010 [accessed August 2011]; 2010;1:CD007354. Available from: http://www.cochrane. org/reviews/clibintro.htm
9. Berrill J, Linnasne S. Morphine for management of refractory dyspnea: opiates should be used with caution. BMJ 2003;327:1288.
10. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE. A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002;57:939-944. (Pubitemid 35316271)
11. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 2003;327:523-528.
12. Supinski G, Dimarco A, Bark H, Chapman K, Clary S, Altose M. Effect of codeine on the sensations elicited by loaded breathing. Am Rev Respir Dis 1990;141:1516-1521. (Pubitemid 20201354)
13. Moosavi SH, Binks AP, Lansing RW, Topulos GP, Banzett RB, Schwartzstein RM. Effect of inhaled furosemide on air hunger induced in healthy humans. Respir Physiol Neurobiol 2007;156:1-8. (Pubitemid 46228091)
14. 2 in ventilated quadriplegics. Respir Physiol 1992;90:19-30.
15. 2-induced air hunger in normal subjects. Respir Physiol 1996;103:19-31.
16. Moosavi SH, Golestanian E, Binks AP, Lansing RW, Brown R, Banzett RB. Hypoxic and hypercapnic drives to breathe generate equivalent levels of air hunger in humans. J Appl Physiol 2003;94:141-154. (Pubitemid 36014306)
17. O'Donnell CR, Schwartzstein RM, Lansing RW, Banzett RB. Descriptor ratings and choices during various forms of laboratory dyspnea [abstract]. Am J Respir Crit Care Med 2010;181:A4803.
18. Banzett RB, Pedersen SH, Schwartzstein RM, Lansing RW. The affective dimension of laboratory dyspnea: air hunger is more unpleasant than work/effort. Am J Respir Crit Care Med 2008;177:1384-1390. (Pubitemid 351860917)
19. Gilman SA, Adams L, Schwartzstein RM, O'Donnell CR, Lansing RW, Banzett RB. Morphine alleviates laboratory dyspnea and diminishes hypercapnic ventilatory response [abstract]. Am J Respir Crit Care Med 2010;181:A4804.
20. 2-induced air hunger. Respir Physiol 1996;105:47-55.
21. 2 and in arterial pH. In: Cherniack NS, Widdicombe JG, editors. Handbook of physiology, section 3: The respiratory system. Washington, DC: American Physiological Society; 1986. pp. 475-528.
22. Meek P, Parshall M, Bittner P, Sklar D, Alcock J. Reliability and validity of the multidimensional dyspnea profile (MDP) in the emergency department and with 4-6 week follow-up [abstract]. Am J Respir Crit Care Med 2010;181:A4800.
23. Parshall M, Meek P, Bittner P, Sklar D, Alcock J. Test-retest reliability of multidimensional dyspnea profile recall ratings in the ED [abstract]. Am J Respir Crit Care Med 2010;181:A4799.
24. American Thoracic Society Ad Hoc Committee. Dyspnea: mechanisms, assessment, and management [consensus statement]. Am J Respir Crit Care Med 1999;159:321-340.
25. Lansing RW, Gracely RH, Banzett RB. The multiple dimensions of dyspnea: review and hypotheses. Respir Physiol Neurobiol 2009;167:53-60.
26. Pattinson KT, Governo RJ, MacIntosh BJ, Russell EC, Corfield DR, Tracey I, Wise RG. Opioids depress cortical centers responsible for the volitional control of respiration. J Neurosci 2009;29:8177-8186.
27. Eiser N, Denman WT, West C, Luce P. Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome. Eur Respir J 1991;4:926-931.
28. CO2 in mechanically ventilated quadriplegics. Respir Physiol 1989;76:53-67.
29. Clemens KE, Quednau I, Klaschik E. Is there a higher risk of respiratory depression in opioid-naive palliative care patients during symptomatic therapy of dyspnea with strong opioids? J Palliat Med 2008;11:204-216. (Pubitemid 351374202)
30. Defares JG. Principles of feedback control and their application to the respiratory control system. In: Fenn W, Rahn H, editors. Handbook of physiology, section 3: Respiration. Washington, DC: American Physiological Society; 1964. pp. 649-680.
31. Gross JB. When you breathe in you inspire, when you don't breathe, you.expire: new insights regarding opioid-induced ventilatory depression. Anesthesiology 2003;99:767-770. (Pubitemid 37186061)
32. Yue HJ, Guilleminault C. Opioid medication and sleep-disordered breathing. Med Clin North Am 2010;94:435-446.
33. Evans KC, Banzett RB, Adams L, McKay L, Frackowiak RS, Corfield DR. BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger. J Neurophysiol 2002;88:1500-1511. (Pubitemid 35025403)
34. von Leupoldt A, Sommer T, Kegat S, Baumann HJ, Klose H, Dahme B, Buchel C. Dyspnea and pain share emotion-related brain network. Neuroimage 2009;48:200-206.
35. Price DD, Von der Gruen A, Miller J, Rafii A, Price C. A psychophysical analysis of morphine analgesia. Pain 1985;22:261-269. (Pubitemid 15043125)
36. Gracely RH, Dubner R, McGrath PA. Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations. Science 1979;203:1261-1263. (Pubitemid 9149473)
37. Casey KL, Svensson P, Morrow TJ, Raz J, Jone C, Minoshima S. Selective opiate modulation of nociceptive processing in the human brain. J Neurophysiol 2000;84:525-533. (Pubitemid 30490070)
38. O'Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA. Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc 2007;4:145-168. (Pubitemid 46743309)
39. Smith J, Albert P, Bertella E, Lester J, Jack S, Calverley P. Qualitative aspects of breathlessness in health and disease. Thorax 2009;64:713-718.
40. O'Donnell DE, Bertley JC, Chau LK, Webb KA. Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med 1997;155:109-115. (Pubitemid 27053150)
41. O'Donnell DE, Ora J, Webb KA, Laveneziana P, Jensen D. Mechanisms of activity-related dyspnea in pulmonary diseases. Respir Physiol Neurobiol 2009;167:116-132.
42. Nishino T, Ide T, Sudo T, Sato J. Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea. Am J Respir Crit Care Med 2000;161:1963-1967. (Pubitemid 30418137)
43. Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, Levy M, Mularski RA, Osborne ML, Prendergast TJ, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008;177:912-927. (Pubitemid 351600670)
44. Bruera E, MacEachern T, Ripamonti C, Hanson J. Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med 1993;119:906-907. (Pubitemid 23316875)
45. Bruera E, Macmillan K, Pither J, MacDonald RN. Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 1990;5:341-344.
46. Bruera E, Sala R, Spruyt O, Palmer JL, Zhang T, Willey J. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage 2005;29:613-618. (Pubitemid 40826484)
47. Allen S, Raut S, Woollard J, Vassallo M. Low dose diamorphine reduces breathlessness without causing a fall in oxygen saturation in elderly patients with end-stage idiopathic pulmonary fibrosis. Palliat Med 2005;19:128-130. (Pubitemid 40443695)
48. Mazzocato C, Buclin T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol 1999;10:1511-1514. (Pubitemid 30017064)
49. Cohen MH, Anderson AJ, Krasnow SH, Spagnolo SV, Citron ML, Payne M, Fossieck BE Jr. Continuous intravenous infusion of morphine for severe dyspnea. South Med J 1991;84:229-234.
50. Light RW, Stansbury DW, Webster JS. Effect of 30 mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD. Chest 1996;109:975-981. (Pubitemid 26113640)
51. Poole PJ, Veale AG, Black PN. The effect of sustained-release morphine on breathlessness and quality of life in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1877-1880.
52. Light RW, Muro JR, Sato RI, Stansbury DW, Fischer CE, Brown SE. Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1989;139:126-133. (Pubitemid 19030433)
53. Johnson MA, Woodcock AA, Geddes DM. Dihydrocodeine for breathlessness in "pink puffers." Br Med J (Clin Res Ed) 1983;286:675-677.
54. Woodcock AA, Gross ER, Gellert A, Shah S, Johnson M, Geddes DM. Effects of dihydrocodeine, alcohol, and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N Engl J Med 1981;305:1611-1616. (Pubitemid 12169189)
55. Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Manage 2007;33:473-481. (Pubitemid 46482946)
56. Clemens KE, Klaschik E. Effect of hydromorphone on ventilation in palliative care patients with dyspnea. Support Care Cancer 2008;16:93-99. (Pubitemid 350243764)
57. Clemens KE, Klaschik E. Morphine in the management of dyspnoea in ALS: a pilot study. Eur J Neurol 2008;15:445-450. (Pubitemid 351499192)
58. Chua TP, Harrington D, Ponikowski P, Webb-Peploe K, Poole-Wilson PA, Coats AJ. Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 1997;29:147-152. (Pubitemid 27028732)