Education Update

Working in residential care we all know that chronic breathlessness is very common in people with COPD (chronic obstructive pulmonary disease) - and it’s often difficult for us to help with.

Chronic breathlessness is breathlessness at rest or at low levels of activity. It is persistent despite the person having the best care for their condition. It restricts a person’s ability to do their activities of daily living and this affects their physical activity leading to cardiac and musculoskeletal deconditioning which results in worsening breathlessness. A vicious cycle of events. Chronic breathlessness is also associated with depression, anxiety and reduced quality of life.

A study in 2018 found that low dose opioids were helpful in breathlessness. BUT, and this is where it gets interesting, it was found that in people getting 20mg/day of long-acting (slow) release morphine versus a placebo DID NOT notice any significant improvement in their breathlessness.

Randomised clinical trials (RCTs) are considered the strongest form of evidence for determining the effectiveness and safety of new treatments or interventions. 

Known as the BEAMS (Breathlessness, Exertion And Morphine Sulphate) Trial, 160 people were randomly put into 3 group - 55 into the morphine 8mg/day group, 53 in the 16mg/day and 52 into the placebo group. After a week their breathlessness symptoms were assessed.

From the BEAMS study it was concluded that daily low dose, slow release morphine does not significantly reduce the intensity of the worst breathlessness after one week of treatment. BUT they also point out that these findings may not be applicable to people with very advanced COPD near end of life and further research is needed.