Once again, I am returning to one of my frequent themes, everything is connected. Many patients with significant COPD will experience breathlessness with and without activity. This symptom will often cause the patient to curtail any activity and is associated with depression and a reduced quality of life. One of the ways physicians have dealt with the issue of breathlessness is to use low dose morphine on a daily basis. One of the biggest concerns other than addiction is the potential for this therapy to increase the slepiness of the patient throughout the day and night creating an additional problem for them.
A recent study looking at the potential to cause increased daytime slepiness in breathless patients taking low dose morphine has found an interesting correlation. While assessing the potential adverse and beneficial effects of morphine in these selected patients, researchers found that improving the sleep pattern of patients with COPD actually improved their symptom of breathlessness.
This effect of morphine on sleep and breathelessness follows a previously discovered relation between the perception of pain and sleep deficiency. This well-established bidirectional relationship between pain and sleep may be at work in patients with breathlessness due to their COPD.
Many other factors need to be considered before this type of therapy can be applied in a universal fashion. Not the least concern, as i have mentioned is addiction but the type of narcotic to use, the doing schedule and screening for apporiate patients must also be defined.
