The Use of Nebulized Opioids in the Management of Dyspnea: Evidence Synthesis

Purpose/Objectives: To analyze the evidence about the use of nebulized opioids to treat dyspnea using the Priority Symptom Management (PRISM) level-of-evidence framework and to make a practice recommendation.

Data Sources: Computerized database and manual search for articles and abstracts that included experimental trials, chart reviews, and case studies.

Data Synthesis: 20 articles with evaluable evidence were identified. Analysis was complex because of heterogeneous variables and outcome measures. A major limitation is small sample sizes. The majority of PRISM level I and II studies indicated unfavorable evidence.

Conclusions: Scientific data supporting the use of nebulized opioids to treat dyspnea in patients with chronic pulmonary disease, including malignancy, are lacking.

Implications for Nursing: Insufficient data identify a need for further research with random crossover designs involving larger samples that are stratified according to prior opioid use. Consistency of study variables should be emphasized.