Current pharmacological strategies for symptomatic reduction of persistent breathlessness – a literature review

ABSTRACT

Introduction

Persistent breathlessness is a debilitating symptom that is prevalent in the community, particularly in people with chronic and life-limiting illnesses. Treatment includes different steps, including pharmacological treatment aiming to improve the symptom and optimize people’s wellbeing.

Areas covered

PubMed and Google Scholar were screened using ‘chronic breathlessness’ OR ‘persistent breathlessness,’ AND ‘pharmacological treatment,’ OR ‘opioids.’ This review focuses on pharmacological treatments to reduce persistent breathlessness and discusses possible mechanisms involved in the process of breathlessness reduction through pharmacotherapy. Research gaps in the field of persistent breathlessness research are outlined, and future research directions are suggested.

Expert opinion

Regular, low-dose (≤30 mg/day), sustained-release morphine is recommended as the first-line pharmacological treatment for persistent breathlessness. Inter-individual variation in response needs to be investigated in future studies in order to optimize clinical outcomes. This includes 1) better understanding the centrally mediated mechanisms associated with persisting breathlessness and response to pharmacological therapies, 2) understanding benefit from the perspective of people experiencing persistent breathlessness, small and meaningful gains in physical activity.

KEYWORDS:

• Chronic obstructive pulmonary disease
• evidence-based care
• quality of life
• persistent breathlessness
• palliative care
• pharmacological treatment
• suffering
• symptom control

Article highlights

• Persistent breathlessness is a disabling symptom, affecting approximately 10% of the population in high-income countries.

• Management for the symptomatic reduction of persistent breathlessness involves a three-step approach: 1) optimize treatment for the underlying condition(s); 2) initiate non-pharmacological measures; and, if necessary, 3) initiate pharmacological treatment.

• Regular, low-dose, sustained-release morphine 10–30 mg/day is the only pharmacological treatment currently licensed anywhere for the symptomatic reduction of persistent breathlessness that has not responded to other measures.

• The characteristics of people most likely to experience net benefit, inter-individual variability in response to opioids and variation in the harms experienced need to be investigated further.

• Future research should focus on identifying the best outcome measures and endpoints in assessing patient-defined benefits from therapy for this symptom.

• Understanding the neural pathways of persistent breathlessness in responders and non-responders will be critical to developing and employing evidence-based management strategies tailored to individuals’ needs in the future.

Acknowledgments

The authors thank Ms. Debbie Marriott for her ready assistance and for her expertise in article formatting and submission.

Declaration of Interest

D Currow is an unpaid advisory board member and a paid consultant for Helsinn Pharmaceuticals, is a paid consultant and receives payment for intellectual property with Mayne Pharma, and is a paid subcontractor to Nous Group Pty Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was not funded.