The efficacy of low-dose systemic opioids for chronic breathlessness was questioned by the recent Cochrane review by Barnes et al. We examined the reasons for this conflicting finding and re-evaluated the efficacy of systemic opioids. Compared with previous meta-analyses, Barnes et al reported a smaller effect and lower precision, but did not account for matched data of crossover trials (11/12 included trials) and added a risk-of-bias criterion (sample size). When re-analysed to account for crossover data, opioids decreased breathlessness (standardised mean differences −0.32; −0.18 to −0.47; I2=44.8%) representing a clinically meaningful reduction of 0.8 points (0–10 numerical rating scale), consistent across meta-analyses.
- Chronic breathlessness
Ekstrom, M., Bajwah, S., Bland, J. M., Currow, D. C., Hussain, J., & Johnson, M. (2018). One evidence base; three stories: do opioids relieve chronic breathlessness? Thorax, 73(1), 88-90. https://doi.org/10.1136/thoraxjnl-2016-209868