Palliation of Dyspnea in Advanced Chronic Obstructive Pulmonary Disease (COPD)
Palliation of Dyspnea in Advanced Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) affects at least 750,000 Canadians and is
 currently the 4th leading cause of death in Canada. Almost everyone with COPD suffers from
 shortness of breath (dyspnea) that worsens over time despite standard treatment (inhalers,
 exercise programs and oxygen). Patients and families have identified relief from dyspnea as a
 top priority for improved care. New approaches are needed for treating advanced COPD to
 lessen the burden that it places on the lives of patients and families alike. Opioid drugs,
 such as morphine, can help in COPD in many ways, including reducing dyspnea, fear and
 anxiety. Opioids are used widely in cancer for similar symptoms. However, there are
 historical biases against their use in advanced COPD (mostly due to fear of side effects when
 much higher doses than the investigators intend have been used in the past). No studies have
 assessed the value to patients of using low dose opioids in advanced COPD in addition to
 conventional treatment. The investigators are planning a study that involves recording
 interviews with about 30 patients and their partner or key family member before and after
 starting treatment with low dose morphine, to understand their experiences with using
 morphine. The investigators will also ask them to complete questionnaires about quality of
 life, dyspnea, anxiety, depression and fear. Descriptions of experiences of using morphine
 have the potential to inform patients, families, clinicians and professional societies about
 the benefits and harms of opioid use for dyspnea in the advanced stages of a common serious
 lung disease when traditional treatments often fail. The investigators will conduct the study
 in both urban (Halifax and Saskatoon) and in a rural setting (New Brunswick). The
 investigators' study of an inexpensive and widely available treatment has the potential to
 improve care and outcomes in advanced COPD for the many Canadians living and dying with this
 serious lung disease.
Inclusion Criteria:

 -  We define advanced COPD as including those with severe COPD by CTS criteria (i.e.,
 severe shortness of breath resulting in the patient being too breathless to leave the
 house, or breathlessness after dressing/undressing (i.e., Medical Research Council
 (MRC) score of 5), or the presence of chronic respiratory failure (PaCO2>45) or
 clinical signs of right heart failure).

 -  We will also include patients who are short of breath and stop walking after about 100
 meters or a few minutes on the level (MRC score 4) with at least one the following:

 -  BMI < 21;

 -  post-bronchodilator FEV1 < 30% predicted;

 -  one or more hospital admissions for acute exacerbation of COPD in the previous
 year.

 -  MRC 4 patients will be recruited only if their baseline Chronic Respiratory
 Questionnaire - dyspnea domain (CRQ-D) score is < 5, an entry criterion used in a
 Canadian RCT involving patients with advanced lung disease.

 Exclusion Criteria:

 -  Patients and/or caregivers with cognitive or other difficulties that would preclude
 questionnaire completion.

 -  Inability to speak or understand English.

 -  Patients considered to be dying or with an expected survival of less than 2 months.