Prescription of opioids for breathlessness in end-stage COPD: a national population-based study

Figures & data

Table 1 Characteristics of oxygen-dependent COPD patients who were prescribed opioids

Characteristic	Total (n=1,034)	Patients with known indication for prescription (n=273)	Patients with unknown indication for prescription (n=302)
Age (years)	74.6±8	72.7±8	75.9±8
Females, n (%)	684 (66)	188 (69)	217 (72)
PaO2 air (kPa)	6.6±0.87	6.7±0.86	6.4±0.86
PaCO2 air (kPa)	6.3±1.2	6.3±1.1	6.4±1.2
WHO status, n (%)
0	49 (5)	17 (6)	11 (4)
1	379 (37)	114 (42)	84 (28)
2	344 (33)	85 (31)	110 (36)
3	145 (14)	22 (8)	56 (18)
4	20 (2)	1 (0)	8 (3)
FEV1 (L)	0.83±0.5	0.86±0.5	0.80±0.5
FEV1 (% of predicted)	34±17.3	34±17.9	33±15.4
Follow-up (days)a	442 (231–754)	568 (262–834)	545 (268–749)

Notes: Data presented as mean ± SD unless stated otherwise. N (%) of missing for PaO₂, 146 (14); PaCO₂, 151 (15); WHO status, 97 (9); FEV₁, 403 (39); FEV₁ (% of predicted), 453 (44).

a Median (first quartile–third quartile).

Abbreviations: FEV₁, forced expiratory volume in 1 second; PaO₂, arterial blood gas tension of oxygen on breathing air; PaCO₂, arterial blood gas tension of carbon dioxide on breathing air; SD, standard deviation; WHO, World Health Organization.

Table 2 Opioid prescriptions in oxygen-dependent COPD

Prescriptions	Random sample n=2,000
Substance, n (%)
Codeine	318 (16)
Dextropropoxifen	270 (14)
Fentanyl	99 (5)
Morphine	314 (16)
Oxycodone	449 (22)
Tramadol	459 (23)
Others	91 (4)
DDDs per prescriptiona	9.3 (3.7–16.7)
Included “as-needed” dose, n (%)	417 (21)

Notes: A random sample of 2,000 (15%) of the total 13,722 opioid prescriptions was analyzed regarding medication type, dispensed amount, date of dispensation, and indication (free text).

a Median (first quartile–third quartile).

Abbreviation: DDDs, defined daily doses.

Table 3 Indications of 2,000 random opioid prescriptions among 575 patients with oxygen-dependent COPD

Indication, n (%)	Overall	6 months before LTOT	First 6 months of LTOT	Last 6 months of LTOT
Known indication	662 (33)	153 (39)	188 (37)	215 (30)
Pain	642 (97)	150 (98)	183 (97)	206 (96)
Breathlessness	13 (2)	1 (0.7)	4 (2)	6 (3)
Other	7 (1)	2 (1)	1 (0.5)	3 (1)
Unknown indication	1,338 (67)	236 (61)	325 (63)	508 (70)

Note: Percentages might not sum to 100 because of rounding.

Abbreviation: LTOT, long-term oxygen therapy.

Table 4 Prescribed opioids at LTOT start versus before death in oxygen-dependent COPD patients who died (n=278)

Indication, n (%)	First 6 months of LTOT	Last 6 months of life
Known indication	75 (28)	106 (29)
Pain	71 (95)	101 (95)
Breathlessness	3 (4)	4 (4)
Other	1 (1)	1 (1)
Unknown indication	191 (72)	265 (71)

Abbreviation: LTOT, long-term oxygen therapy.

Table 5 Indications of opioid prescriptions by WHO performance status in oxygen-dependent COPD

Indication, n (%)	WHO status 0	WHO status 1	WHO status 2	WHO status 3	WHO status 4
Known indication	38 (45)	273 (42)	224 (32)	55 (17)	2 (7)
Pain	38 (100)	269 (99)	211 (94)	53 (96)	2 (100)
Breathlessness	0	2 (0.7)	8 (4)	2 (4)	0
Other	0	2 (0.7)	5 (2)	0	0
Unknown indication	47 (55)	374 (58)	485 (68)	275 (83)	28 (93)

Notes: Percentages might not sum to 100 because of rounding. WHO status: 0, fully active, able to carry out all pre-disease activities without restriction; 1, restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, eg, light house work, office work; 2, ambulatory and capable of all selfcare but unable to carry out any work activities, and up and about more than 50% of waking hours; 3, capable of only limited selfcare, confined to bed or chair more than 50% of waking hours; 4, completely disabled, incapable of any selfcare, totally confined to bed or chair.

Abbreviation: WHO, World Health Organization.

Figure 1 Trend for stated indications of opioid prescriptions in 575 patients with oxygen-dependent COPD.

Notes: Percentage of dispensed opioid prescriptions with the indication for pain, breathlessness, or other (of the prescriptions with known indication; N=662; 33%). Time periods are 3 months before starting LTOT (−3 to 0 months), and each quartile (Q1–Q4) of follow-up during LTOT.