The role of inhaled morphine in the management of breathlessness in terminally ill patients

Dyspnoea may be defined as the subjective sensation of difficult or uncomfortable breathing. Estimates of the incidence of dyspnoea range from 21 % to 70 % of terminally ill patients. A wide range of pathological conditions from lymphangitis carcinomatosis, plueral effusion and multiple pulmonary metastases ascites or anaemia may produce dyspnoea.

Unfortunately satisfactory symptomatic control of dyspnoea has been difficult to achieve. Reviews of pharmacological management have emphasised that the control of dyspnoea in terminal patients is extremely difficult and that goal of a clinician must be directed at a drug treatment which is effective in relieving the patients feeling of suffocation.

To date the most effective symptomatic relief of dyspnoea has been achieved with use of morphine. It is known that morphine in the oral, intravenous or subcutaneous form is very beneficial for the palliation of this symptom. There are anecdotal reports of the benefits of nebulised morphine in the terminally ill, but as yet no documented evidence on its effects.

The aim of this study is to evaluate the effectiveness of nebulised morphine in treating dyspnoea in the terminally ill patient. Patients entered in the trial are randomly allocated to receive either nebulised saline or nebulised Morphine in saline on a double blind, crossover basis. Assessment will be by patients completing a visual analogue scale assessing the level of dyspnoea they experience. All patients will be able to request morphine syrup for alleviation of dyspnoea at any stage throughout the trial.