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. 1996 Jun;51(6):596–600. doi: 10.1136/thx.51.6.596

Effect of inhaled morphine on the development of breathlessness during exercise in patients with chronic lung disease.

R Leung 1, P Hill 1, J Burdon 1
PMCID: PMC1090489  PMID: 8693440

Abstract

BACKGROUND: Inhaled morphine has previously been shown to increase exercise endurance in patients with chronic lung disease. A similar study was performed to determine whether inhaled morphine reduces the sensation of breathlessness in this group of patients. METHODS: A randomised double blind study on the effect of nebulised morphine on both exercise induced breathlessness and maximum achievable power output using isotonic saline as a control was performed in 10 patients with stable chronic lung disease. Each subject performed a progressive exercise test (Jones' stage I) on an electrically braked cycle ergometer. The work load was increased by 10 watts per minute and subjects exercised to exhaustion. At the end of each minute of exercise patients were asked to rate their degree of breathlessness according to a modified Borg scale. All subjects were randomised to receive either inhaled morphine sulphate 1 mg/ml (5 ml) or isotonic saline (5 ml) by wet nebulisation. The effect of morphine and saline on the achieved exercise capacity and the development of breathlessness during exercise was tested on separate days. RESULTS: The mean dose of morphine inhaled was 1.24 mg. There was no difference in maximum power output achieved, minute ventilation at maximum power output, nor the degree of breathlessness at maximum power output between the groups treated with morphine and placebo. The degree of breathlessness was related to the power output achieved during exercise by a power function relationship (mean r: morphine = 0.86, saline = 0.87). However, there was a wide variation in the sensation for any given power output in both groups. There was no difference in the group mean slopes (morphine = 1.15, saline = 1.00) or intercepts (morphine = 0.07, saline = 0.15) in this relationship between the morphine and saline treatment groups. CONCLUSIONS: In patients with severe chronic lung disease inhaled morphine in the doses used in this study does not relieve exercise induced breathlessness nor does it increase maximum power output achieved during progressive exercise.

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Selected References

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  1. Bostwick D. G., Null W. E., Holmes D., Weber E., Barchas J. D., Bensch K. G. Expression of opioid peptides in tumors. N Engl J Med. 1987 Dec 3;317(23):1439–1443. doi: 10.1056/NEJM198712033172304. [DOI] [PubMed] [Google Scholar]
  2. Burdon J. G., Pain M. C., Rubinfeld A. R., Nana A. Chronic lung diseases and the perception of breathlessness: a clinical perspective. Eur Respir J. 1994 Jul;7(7):1342–1349. doi: 10.1183/09031936.94.07071342. [DOI] [PubMed] [Google Scholar]
  3. Burns B. H., Howell J. B. Disproportionately severe breathlessness in chronic bronchitis. Q J Med. 1969 Jul;38(151):277–294. [PubMed] [Google Scholar]
  4. Eiser N., Denman W. T., West C., Luce P. Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome. Eur Respir J. 1991 Sep;4(8):926–931. [PubMed] [Google Scholar]
  5. Johnson M. A., Woodcock A. A., Geddes D. M. Dihydrocodeine for breathlessness in "pink puffers". Br Med J (Clin Res Ed) 1983 Feb 26;286(6366):675–677. doi: 10.1136/bmj.286.6366.675. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Light R. W., Muro J. R., Sato R. I., Stansbury D. W., Fischer C. E., Brown S. E. Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1989 Jan;139(1):126–133. doi: 10.1164/ajrccm/139.1.126. [DOI] [PubMed] [Google Scholar]
  7. Man G. C., Hsu K., Sproule B. J. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest. 1986 Dec;90(6):832–836. doi: 10.1378/chest.90.6.832. [DOI] [PubMed] [Google Scholar]
  8. Masood A. R., Reed J. W., Thomas S. H. Lack of effect of inhaled morphine on exercise-induced breathlessness in chronic obstructive pulmonary disease. Thorax. 1995 Jun;50(6):629–634. doi: 10.1136/thx.50.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mitchell-Heggs P., Murphy K., Minty K., Guz A., Patterson S. C., Minty P. S., Rosser R. M. Diazepam in the treatment of dyspnoea in the 'Pink Puffer' syndrome. Q J Med. 1980 Winter;49(193):9–20. [PubMed] [Google Scholar]
  10. Noseda A., Schmerber J., Prigogine T., Yernault J. C. Perceived effect on shortness of breath of an acute inhalation of saline or terbutaline: variability and sensitivity of a visual analogue scale in patients with asthma or COPD. Eur Respir J. 1992 Oct;5(9):1043–1053. [PubMed] [Google Scholar]
  11. O'Neill P. A., Morton P. B., Stark R. D. Chlorpromazine--a specific effect on breathlessness? Br J Clin Pharmacol. 1985 Jun;19(6):793–797. doi: 10.1111/j.1365-2125.1985.tb02716.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. O'Neill P. A., Stark R. D., Morton P. B. Do prostaglandins have a role in breathlessness? Am Rev Respir Dis. 1985 Jul;132(1):22–24. doi: 10.1164/arrd.1985.132.1.22. [DOI] [PubMed] [Google Scholar]
  13. Santiago T. V., Remolina C., Scoles V., 3rd, Edelman N. H. Endorphins and the control of breathing. Ability of naloxone to restore flow-resistive load compensation in chronic obstructive pulmonary disease. N Engl J Med. 1981 May 14;304(20):1190–1195. doi: 10.1056/NEJM198105143042002. [DOI] [PubMed] [Google Scholar]
  14. Stark R. D., Gambles S. A., Lewis J. A. Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide. Clin Sci (Lond) 1981 Oct;61(4):429–439. doi: 10.1042/cs0610429. [DOI] [PubMed] [Google Scholar]
  15. Stark R. D., Morton P. B., Sharman P., Percival P. G., Lewis J. A. Effects of codeine on the respiratory responses to exercise in healthy subjects. Br J Clin Pharmacol. 1983 Mar;15(3):355–359. doi: 10.1111/j.1365-2125.1983.tb01510.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Woodcock A. A., Gross E. R., Geddes D. M. Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Br Med J (Clin Res Ed) 1981 Aug 1;283(6287):343–346. doi: 10.1136/bmj.283.6287.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Woodcock A. A., Gross E. R., Gellert A., Shah S., Johnson M., Geddes D. M. 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 Dec 31;305(27):1611–1616. doi: 10.1056/NEJM198112313052703. [DOI] [PubMed] [Google Scholar]
  18. Young I. H., Daviskas E., Keena V. A. Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. Thorax. 1989 May;44(5):387–390. doi: 10.1136/thx.44.5.387. [DOI] [PMC free article] [PubMed] [Google Scholar]

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