Oral morphine significantly improved breathlessness in patients with NYHA III/IV chronic heart failure, reducing the median breathlessness score by 23 mm by day 2 (P=0.022).
RCT (n=10)
Double-blind
Crossover
Does oral morphine reduce breathlessness in out-patients with NYHA III/IV chronic heart failure?
Low-dose oral morphine may provide effective short-term relief of breathlessness in patients with advanced chronic heart failure, highlighting its potential as a palliative therapy.
Effect estimate: 23 mm reduction in median breathlessness score
p-value: p=0.022
Abstract Background Chronic heart failure (CHF) patients can experience significant breathlessness despite maximum medication for their heart failure. Morphine has long been used to relieve symptoms in acute failure, but there is little evidence about this potentially useful palliative therapy in CHF. Aims To determine the efficacy of morphine for the relief of breathlessness in patients with CHF. Method Ten out-patients with NYHA III/IV CHF entered a randomised, double-blind, placebo controlled, crossover pilot study. The active arm was 4 days of 5 mg oral morphine four times daily (2.5 mg morphine if creatinine 200 μmol/l). There were 2 days wash-out between active and placebo arms. Results 6/10 patients indicated that morphine improved their breathlessness. On morphine, the median breathlessness score fell by 23 mm (P=0.022) by day 2. The improvement was maintained. Sedation scores increased until day 3 (P=0.013), reducing on day 4. Four patients developed constipation (P=0.026). On placebo, there was no significant difference in breathlessness or sedation. One patient had constipation. There were no significant differences in either arm in nausea, quality of life scores, blood pressure, pulse, respiratory rate, or catecholamines. Brain natriuretic peptide fell in both arms; significantly in the morphine arm. Conclusion Morphine relieves breathlessness due to CHF. A larger study is indicated.
Johnson et al. (Mon,) conducted a rct in Chronic heart failure (n=10). Morphine vs. Placebo was evaluated on Relief of breathlessness (23 mm reduction in median breathlessness score, p=0.022). Oral morphine significantly improved breathlessness in patients with NYHA III/IV chronic heart failure, reducing the median breathlessness score by 23 mm by day 2 (P=0.022).
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