Opioids for breathlessness: a narrative review

ABSTRACT Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of management and should be optimised prior to use of opioid medication. Opioids are being implemented variably in practice for chronic breathlessness. This narrative review summarises the evidence defining current opioids for breathlessness best practice and identifies remaining research gaps.There is level 1a evidence to support the use of opioids for breathlessness. The best evidence is for 10mg to 30mg daily de novo low dose oral sustained-release morphine in opioid-naïve patients. This should be considered the current standard of care following independent, regulatory scrutiny by one of the world’s therapeutics regulatory bodies.Optimal benefits are seen in steady state, however, there are few published data about longer term benefits or harms. Morphine-related adverse events are common but mostly mild and self-limiting on withdrawal of drug. Early and meticulous management of constipation, nausea and vomiting is needed particularly in the first week of administration. Serious adverse events are no more common than placebo in clinical studies. Observational studies in severe chronic lung disease do not show excess mortality or hospital admission in those taking opioids. We have no long term data on immune or endocrine function.There are promising data regarding prophylaxis for exertion-related breathlessness, but given the risks associated with transmucosal fentanyl, caution is needed with regard to clinical use pending longer-term, robust safety data

General practice activity in Australia 2014–15

This is the 17th annual report and the 38th book in the General Practice Series from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity in Australia.Australian Government Department of Health, AstraZeneca Pty Ltd (Australia), Novartis Pharmaceuticals Australia Pty Ltd, bioCSL (Australia) Pty Ltd, AbbVie Pty Ltd, Australian Government Department of Veterans' Affair

General practice activity in Australia 2014–15

This is the 17th annual report and the 38th book in the General Practice Series from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity in Australia.Australian Government Department of Health, AstraZeneca Pty Ltd (Australia), Novartis Pharmaceuticals Australia Pty Ltd, bioCSL (Australia) Pty Ltd, AbbVie Pty Ltd, Australian Government Department of Veterans' Affair

A decade of Australian general practice activity 2006–07 to 2015–16

This report will be made available in full on TUESDAY 30 AUGUST 2016. This report is the 41st and last book in the General practice series from the Bettering the Evaluation of Care and Health (BEACH) program. It includes summary results from the most recent 10 years of the program, from 2006–07 to 2015–16 inclusive