Japanese Journal of Clinical Oncology, Vol 29, Issue 12 600-603, Copyright © 1999 by Foundation for Promotion of Cancer Research
K Tanaka, Y Shima, R Kakinuma, K Kubota, Y Ohe, F Hojo, T Matsumoto, H Ohmatsu, K Goto, K Nagai and Y Nishiwaki
BACKGROUND: It is known that opioids may decrease subjective dyspnea. The
recent finding that opioid binding sites are present in the peripheral
bronchus supports the possibility of a local action of opioids. However,
the clinical benefit of nebulized morphine is controversial. The purpose of
this study was to confirm the feasibility of nebulized morphine and to
evaluate its clinical benefits. PATIENTS AND METHODS: Fifteen cancer
patients with dyspnea in the Thoracic Oncology Division and Palliative Care
Unit in the National Cancer Center Hospital East were given 20 mg of
morphine hydrochloride dissolved in 5 ml of normal saline through an
ultranebulizer. The subjective effects were evaluated using a visual analog
scale (VAS) immediately before and 60 min after inhalation. Respiratory
rate (RR), hemoglobin oxygen saturation (SpO2) and blood pressure also were
measured twice at these two time points. A questionnaire about adverse
reactions was included. RESULTS: No major adverse reactions such as
respiratory depression, sleepiness, nausea or vomiting were observed. VAS
was significantly decreased after nebulization (p = 0.005) without any
significant change in RR or SpO2. In eight of 15 patients, dyspnea was
improved as measured by a decrease in VAS of more than 10%. This correlated
with the desire of the patients to continue its use. CONCLUSION: Our
preliminary data confirmed the feasibility of nebulized morphine and
suggested its possible clinical benefit for dyspneic patients. A randomized
controlled study is warranted to exclude a placebo effect and to compare
the clinical benefits of nebulized morphine with those of other methods of
treatment.
CASE REPORTS
Effect of nebulized morphine in cancer patients with dyspnea: a pilot study
Thoracic Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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