Palliative Care in COPD, a survey of treating dyspnea with opioids

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, affects around 5% of the population and is associated with high morbidity and mortality. The most common and one of the cardinal symptoms of COPD is exertional dyspnea. Data from several trials and systematic reviews demonstrate the benefits of systemically administered opioids in treating breathlessness, mostly in the advanced stages of COPD. Questions: Oral Transmucosal Fentanyl Citrate , thanks to its rapid onset, has been recently studied in relation to exertional dyspnea among cancer patients, and has shown promising results. In Palliative Care daily practice in our area (Mallorca Island, Spain), we see the use of Oral Transmucosal Fentanyl Citrate prescribed as an off label treatment of exertional dyspnea in advanced stage chronic patients. Methods: We plan to conduct an anonymous and self-reported questionnaire regarding daily practice prescriptions, of Mallorca (Spain) area Respiratory Medicine and Palliative Care Specialists´ opioids treatment of symptomatic dyspnea in advanced stage COPD patients. Outcomes: 43 completed questionnaires were obtained, representing 93.75% of the total number of professionals of PC and 77.8% of Pneumologists in the Mallorca public health service. Main used opioid is Morphine (88.5%) Discussion: Half of participants responded that they regularly use transmucosal fentanyl for acute dyspnea, 25% of the Pneumologists interviewed, and 93% of PC Specialists and it is an off-label treatment, with not powerful studies to suggest this prescription. Take Home Message for Practice Results build real world evidence about Palliative Care daily practice and dyspnea managing.