Trick of the Trade: Opioids for air hunger

A patient presents with significant shortness of breath from a COPD exacerbation. His room air saturation is 80%, respiratory rate of 30, and is uncomfortably seated in a tripod position. You administer the usual regimen:

• Oxygen by face mask
• Nebulized albuterol and atrovent
• Solumedrol
• Bipap
• Set up for possible intubation

With the Bipap mask on, the patient's subjective sense of dyspnea and "air hunger" seems to make it harder for him to tolerate the tight-fitting mask.

Trick of the Trade:
Use a small dose of IV fentanyl

A 2001 Cochrane review evaluated studies involving non-nebulized opioids to treat symptomatic breathlessness. The review found a small statistically significant improvement in subjective air hunger, although most studies were with small sample size numbers.


Reference
Jennings AL, Davies AN, Higgins JP, Broadley K. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001;(4):CD002066. Pubmed
.