Morphine capsules for drivers with chronic breathlessness

People with chronic breathlessness enjoy getting back in the driver’s seat when their symptoms are better controlled – with researchers finding that low-dose, extended release morphine capsules may help with this.

Being able to drive a vehicle has been identified as an important issue for people with chronic breathlessness, a problem frequently encountered by people with a range of life-limiting illnesses including cancer, end-stage respiratory disease, chronic heart failure and some neuro-degenerative diseases.

Australia is the first country in the world to approve regular, low-dose, sustained-release morphine capsules for the treatment of chronic breathlessness, and researchers at Flinders University connected to the Palliative Care Clinical Studies Collaborative (PaCCSC) have interviewed patients with chronic breathlessness and, separately, their caregivers to learn their thoughts on what tasks would be achievable if their chronic breathlessness was better controlled.

More than 300,000 people across Australia who suffer from chronic breathlessness – and especially the 75,000 who are housebound with extremely limited day-to-day activity – could benefit from the research being conducted.

“Driving is a particularly valued part of most people’s lives and helps to maintain a sense of normality and independence when there are lots of losses as people experience a life-limiting illness,” says Professor David Currow, who leads PaCCSC.

“Any therapy that could reduce the sensation of chronic breathlessness safely is beneficial in optimising such things as driving and will be very beneficial to these patients.”

The PaCCSC team has recently issued papers that support the use of regular, low-dose, sustained-release morphine to help people with chronic breathlessness in performing tasks such as driving vehicles.

“Although people have fears surrounding driving while taking morphine, regular low-dose sustained-release morphine does not seem to impact on patients’ self-perceived driving ability,” says Professor Currow.

The key paper – “Patients’ and caregivers’ experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study,’ by Diana Ferreira, Jason Boland, Slavica Kochovska, Aaron Honson, Jane Phillips and David Currow – has been published in Palliative Medicine journal (DOI: 10.1177/0269216320929549).

This study continues long-term research that has been undertaken by Flinders University since 2002, measuring the benefits and harms of using a regular low-dose, extended-release morphine capsule to relieve the debilitating effects of chronic breathlessness.

“Chronic refractory breathlessness affects every aspect of life, even at rest or with minimal exertion despite optimal treatment of the underlying causes,” says Professor Currow, who has spent the past 23 years investigating better treatments for the condition.

“As the population ages, more people will experience chronic breathlessness as a result of emphysema, heart failure and cancer. Finding ways to reduce breathlessness will help to reduce suffering across our community,” he says.

“Further clinical research should focus on investigating whether oral, low-dose sustained-release morphine impacts on patients’ driving ability, particularly during initiating therapy and any subsequent dose changes.”

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