Editor – We thank Drs Patel and Davies for their comments and agree with their observations on the evidence base for the use of opioids and benzodiazepines for the relief of breathlessness in lung disease. Many treatments used in palliative medicine lack evidence from randomised controlled trials, which can be difficult to undertake. This applies to treatments for anorexia, fatigue, sweating and itch, as well as for breathlessness. The Cochrane review by Simon et al did not show a beneficial effect for benzodiazepines in breathless patients but showed a trend towards benefit which they considered sufficient to justify considering an individual therapeutic trial when opioids and non-pharmacological measures have failed.1
When a patient has a difficult symptom, we tend to use the treatment with best evidence initially, but often need to resort to less tried and tested therapies if unsuccessful, while awaiting the results of better, adequately powered studies.
Reference
- 1.Simon ST, Higginson IJ, Booth S, et al. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant disease in adults. Cochrane Database Syst Rev 2010;20:CD007354. [DOI] [PubMed] [Google Scholar]