166 Opioids for breathless hospital inpatients: moving towards evidence-based practice

<h3>Background</h3> Breathlessness is a distressing symptom experienced by many people with long-term conditions. Although opioids are used to try to relieve breathlessness, several large recent trials have demonstrated a lack of benefit and adverse effects. Emerging international guidance does not support opioid use, other than when chronic breathlessness persists despite non-pharmacological symptom self-management. Current best practice still supports opioid use in the last days of life, given the lack of research involving this patient group. This evaluation aimed to assess the alignment of hospital opioid prescribing for breathlessness with evidence and best practice. <h3>Methods</h3> A retrospective audit was performed involving all inpatients prescribed morphine sulphate or oxycodone on medical wards in a large UK tertiary hospital. Case notes were interrogated to review prescribing practice, determine optimisation of non-pharmacological approaches and find out whether opioid use was reviewed. <h3>Results</h3> A total of 780 patients were prescribed opioids over a 6-week period, of which 129 (17%) were for breathlessness and the rest for pain. Most opioids prescribed for breathlessness were for people in the last days of life (113/129, 88%). Of the 16 patients not at the end of life, none were prescribed opioids appropriately. 7 did not have breathlessness correctly documented as the indication on the prescription itself, and 6 had acute or acute-on-chronic breathlessness requiring medical management rather than opioids. Eleven patients had not had optimisation of non-pharmacological strategies and none had a documented review of the impact of opioids. Most (13/16) did have laxatives co-prescribed. <h3>Conclusion</h3> For inpatients not in the last days of life, opioid prescribing for breathlessness was poor. Given the lack of evidence for opioids relieving breathlessness, non-pharmacological self-management approaches must be prioritised, with associated health professional education. Opioids should only subsequently be considered for intractable breathlessness, with accurate prescribing and careful monitoring.