February 2019 – Treating dyspnea improves function in late stage COPD and CHF.
Consider using a low-dose opioid 30 – 60 minutes before planned exertion to improve activity tolerance. Patients with palliative goals are excluded from opioid prescribing guidelines. Charting these goals is adequate; a consultation is not required. Your chart might read “This patient has advanced COPD with breathlessness that reduces quality of life. Opioids are being used as part of a palliative care approach.”
Typical starting doses would be liquid morphine concentrate 20 mg/ml, 1-2 mg sublingually, or ¼- ½ of a hydrocodone/APAP 5/325 tablet.
Remember prunes, senna, or Miralax to prevent opioid-induced constipation.