Yes, low-dose morphine is an effective and recommended treatment for managing severe, chronic breathlessness (dyspnea) in patients with end-stage Chronic Obstructive Pulmonary Disease (COPD). It is a key component of palliative care for these patients.
For patients with severe or very severe COPD in groups C and D, the first choice recommendation is to use inhaled corticosteroids (ICSs) in combination with a long-acting B2 agonist (LABA) or monotherapy with a long-acting anticholinergic (LAAC).
Chronic breathlessness is a frequent symptom in advanced Chronic Obstructive Pulmonary Disease (COPD) and has major impact on quality of life, daily activities and healthcare utilization. Morphine is used as palliative treatment of chronic breathlessness.
Morphine is a reliable and effective method to combat shortness of breath. Beyond providing relief from the sensation of not being able to take in adequate amounts of air, it will also help reduce any agitation or anxiety a patient may feel due to its calming effects.
The short answer is no—when used appropriately, morphine does not speed up death in hospice patients. Many people worry about the use of morphine in hospice care.
Morphine at a large dose strongly decreases oxygen levels but modestly increases them when administered at low and moderate doses. Morphine also induced distinct changes in brain temperature, eliciting increases at low and moderate doses and a biphasic, down-up change at a higher dose.
Morphine is an opiate, a strong drug used to treat serious pain. Sometimes, morphine is also given to ease the feeling of shortness of breath. Successfully reducing pain and addressing concerns about breathing can provide needed comfort to someone who is close to dying.
In the last 48 hours of life, common symptoms include significant changes in breathing (faster, slower, pauses, noisy), increased sleep/unresponsiveness, confusion or delirium, cold/mottled skin (especially extremities), decreased appetite/thirst, loss of bladder/bowel control, and restlessness, often with a "death rattle" from fluid buildup, as the body slows down and organs begin to shut down, emphasizing comfort care.
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
Symptoms of End-Stage COPD
Just breathing takes a lot of effort. You might feel out of breath without doing much of anything. Flare-ups may happen more often, and they tend to be more severe. You may also get a condition called chronic respiratory failure.
When morphine is given, deep breathing ceases. It appears that morphine, in doses which do not grossly depress ventilation and exchange of gases, may depress the reflex urge to maintain normal pulmonary mechanics. This may explain the increased incidence of postoperative atelectasis following large doses of narcotics.
In mild to moderate COPD, most deaths are due to cardiovascular disease and lung cancer, but as COPD severity increases, respiratory deaths are increasingly common.
Palliative care is specialized medical care focused on treating the symptoms and stress of serious illnesses like COPD. Palliative care is available to you from the moment you are diagnosed and through the entire course of your illness.
Dupixent expands label, gets approved for COPD treatment
This made the drug the first biological treatment for patients with COPD in the U.S. Dupixent is a fully human monoclonal antibody that inhibits the signaling of the IL4 and IL13 pathways, but it is not an immunosuppressant.
Life expectancy with stage 4 COPD varies depending on age, overall health, smoking history, and the presence of other medical conditions. Studies suggest that individuals with very severe COPD may have a life expectancy ranging from a few months to a few years, with an average of about 2 to 5 years.
During 1 to 2 weeks before death, the person may feel tired and drained all the time, so much so that they don't leave their bed. They could have: Different sleep-wake patterns. Little appetite and thirst.
As people get closer to dying, they may sleep more, become drowsy or be difficult to wake. They may fall asleep while talking. A person may slowly lose consciousness in the days or hours before death. When visiting someone with advanced cancer, be aware that visiting may be tiring and difficult for the dying person.
If you move the person, be very gentle and tell them what you are doing. A few layers of light, warm clothing and bedding can help to keep them at a comfortable temperature. As the person gets closer to death, their breathing pattern will probably change.
(higher doses of morphine may be appropriate if the patient is already receiving regular strong opioids for pain). Combining opioids and midazolam to manage breathlessness and anxiety in the last days of life is common practice in palliative care.
These similarities are known as the “morphine rule” in which compounds generally incorporate into their carbon framework (1) a tertiary nitrogen with a small alkyl substituent; (2) a quaternary carbon; (3) a phenyl ring or its equivalent attached to the quaternary carbon; and (4) an ethyl linker between the quaternary ...
Most commonly used in pain management, morphine provides significant relief to patients afflicted with pain. [1] Clinical situations that benefit significantly from medicating with morphine include management of palliative/end-of-life care, active cancer treatment, and vaso-occlusive pain during sickle cell crisis.
Low-dose morphine may be prescribed to reduce chronic breathlessness in COPD. Subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated.
With morphine dilatating vessels and increasing oxygenation, it's like breathing while sleeping. Breathing slows down to match their body's demand, not stopping it. Myth: Morphine can speed up death.
In the present study, morphine increased baseline MAP and MSNA and reduced HR.