Nebulized morphine curbs cancer-related dyspnea

Nebulized morphine appears to be as effective as subcutaneous morphine for improving dyspnea in cancer patients, according to researchers.

Although systemic morphine is the standard treatment, Dr. Eduardo Bruera and colleagues note in the June issue of the Journal of Pain and Symptom Management that it has certain disadvantages. The medication’s effect is delayed, and it also has a sedating effect on patients who may already be cognitively impaired.Nebulized morphine has the potential to act more quickly, is relatively easy to administer, and could sidestep the sedating side effects that occur with systemic administration, they add. To compare the two routes of treatment, Dr. Bruera of the University of Texas M.D. Anderson Cancer Center in Houston and his team studied 11 cancer patients with dyspnea. All had resting dyspnea intensity of at least 3 based on a 10-point scale.Patients received either subcutaneous morphine and a nebulized placebo on the first day of the study, or nebulized morphine and a subcutaneous placebo. They crossed over on the second day. The median dose given daily was 45 mg, and ranged from 7.5 to 200 mg.After subcutaneous morphine, the average dyspnea score dropped from 5 to 3. After nebulized morphine, the corresponding drop was from 4 to 2. Both reductions were significant, but the study did not have sufficient statistical power to identify a difference in effectiveness between the two routes of administration. In both groups, reduction in dyspnea persisted for about 4.5 hours. More sedation was seen with subcutaneous treatment.Dr. Bruera and colleagues note that patients in the current study had relatively mild symptoms, and it is possible the findings might not be applicable to those with more severe dyspnea.Nevertheless, they conclude that the results “justify randomized controlled trials both in patients with continuous dyspnea and in patients with earlier stages of dyspnea.” (Source: J Pain Symptom Manage 2005;29:613-618: Reuters Health: Oncolink: July 2005.)