Inhaled morphine eases cancer-related air hunger

When patients with advanced cancer develop severe difficulty in breathing, an inhalation of morphine can relieve the symptoms, researchers report. In fact, they found that nebulized morphine appears to be as effective as subcutaneous injections of the drug, and perhaps has advantages.

Dr. Eduardo Bruera and colleagues note in the Journal of Pain and Symptom Management that air hunger, or dyspnea, "is a frequent and devastating symptom in patients with advanced cancer."

Although injected morphine is the standard treatment for cancer-related dyspnea, it has certain disadvantages. The medication's effect is delayed, and it also has a sedating effect, the researchers point out.

Nebulized morphine has the potential to act more quickly, is relatively easy to administer, and could sidestep the sedating side effects that occur with injections, they add.

To compare the two approaches, Bruera, of the University of Texas M.D. Anderson Cancer Center in Houston, and his team studied 11 cancer patients with dyspnea. All had dyspnea intensity of at least 3 on a 10-point scale.

On the first day of the study, patients received either subcutaneously injected morphine and a nebulized placebo, or nebulized morphine and a subcutaneous placebo. They crossed over on the second day.

After subcutaneous morphine, the average dyspnea score dropped from 5 to 3. After nebulized morphine, the corresponding drop was from 4 to 2. Both reductions were significant, and the effect lasted for about 4.5 hours.

More sedation was seen with subcutaneous treatment.

Bruera and colleagues note that patients in the current study had relatively mild symptoms, and it is possible the findings might not be applicable to those with more severe dyspnea.

Nevertheless, they conclude that the results "justify randomized controlled trials both in patients with continuous dyspnea and in patients with earlier stages of dyspnea."

SOURCE: Journal of Pain and Symptom Management, June 2005.