Extract
Chronic breathlessness syndrome, defined as breathlessness that persists despite optimal treatment of the underlying pathophysiology, resulting in disability, is a major problem for patients with advanced chronic lung disease, and can be difficult to manage [1, 2]. Opioids should be considered for treatment of these patients [3]. Episodic breathlessness is severe worsening of breathlessness intensity, which can be predictable or unpredictable [4]. Episodic breathlessness can have a major impact on activities of daily life, but ∼90% of episodes last for 20 min or less [5]. Therefore, the selection of appropriate palliative pharmacological therapy is a complex issue. Indeed, the onset of action of short-acting oral opioids is between 15 and 30 min [6]. The rapid onset of action (between 1 and 4 min [7]) is the major advantage of fentanyl nasal spray. This case report relates the experience and insight gained when fentanyl nasal spray was prescribed to a patient with end-stage chronic obstructive pulmonary disease (COPD) and the lessons we have learned. Written informed consent for publication of the clinical details was obtained from the deceased patient's spouse.
Abstract
Insufficient control of chronic breathlessness may induce excessive use of fentanyl nasal spray in COPD patients. Prescription of fentanyl nasal spray for breathlessness should only be done as part of palliative treatment and requires close follow-up. http://bit.ly/2YdOjJ1
Footnotes
Conflict of interest: D.J.A. Janssen reports personal fees for lectures from Boehringer Ingelheim, Novartis, AstraZeneca and GlaxoSmithKline, outside the submitted work.
Conflict of interest: M.H.J. van den Beuken-van Everdingen reports personal fees for lectures from Takeda and Mundipharma, outside the submitted work.
Conflict of interest: C.A. Verberkt has nothing to disclose.
Conflict of interest: J.P.H.M. Creemers has nothing to disclose.
Conflict of interest: E.F.M. Wouters reports personal fees for board membership from Nycomed and Boehringer Ingelheim, personal fees for lectures from AstraZeneca, GlaxoSmithKline, Novartis and Chiesi, and grants from AstraZeneca and GlaxoSmithKline, outside the submitted work.
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