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Journal of Pain & Palliative Care Pharmacotherapy Volume 27, 2013 - Issue 3
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Research Article

Opioid Use in End-of-Life Care in Patients With Interstitial Pneumonia Associated With Respiratory Worsening

Hiroaki TsukuuraHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.Correspondence[email protected]
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Koichi NishimuraHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Hiroyuki TaniguchiHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Yasuhiro KondohHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Tomoki KimuraHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Kensuke KataokaHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Naohiro WatanabeHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Yoshinori HasegawaHiroaki Tsukuura, MD, Naohiro Watanabe, MD, and Yoshinori Hasegawa, MD, are with the Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Koichi Nishimura, MD, is with the Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan. Hiroyuki Taniguchi, MD, Yasuhiro Kondoh, MD, Tomoki Kimura, MD, and Kensuke Kataoka, MD, are with the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
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Pages 214-219 | Received 23 Feb 2013, Accepted 30 Apr 2013, Published online: 25 Jul 2013
 
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ABSTRACT

The authors investigated the treatment outcome of patients with severe interstitial pneumonia (IP) who received opioids during end-of-life care. Twenty-two consecutive patients were retrospectively evaluated before and after continuous administration of opioids for 24 hours. All subjects died within 21 days; the mean survival period after opioid administration was 5.6 days. Six of the 22 patients (27%) died within 24 hours after opioids were initiated. In the other 16 patients, respiratory rate was significantly decreased after opioid use and there was a small, nonsignificant improvement in dyspnea measured by the Borg scale without adequate evaluation and records (n = 6). However, hypercapnia with over 10 mm Hg of Paco2 developed in two patients. Paco2 tended to be elevated after opioid use in all patients, although the change was not significant. An extremely poor outcome was attributable to the disease progression of IP in six of the patients with Pao2/FIo2 levels below 100. The other 16 patients showed both positive and negative effects as expected. Clinicians should assess dyspnea prior to opioid administration, since the purpose of the opioid administration is to relieve dyspnea. Dyspnea should be monitored and recorded in routine clinical practice, at least after hospitalization.

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