Opioids for breathlessness in people with primary hypertension.

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Dyspnoea is a source of physical and psychological distress, and is one of the most commonly feared aspects of the dying process. By definition, people with severe primary pulmonary hypertension have breathlessness, despite maximal therapy and recent advances in therapies for primary pulmonary hypertension. In parallel with attempting to treat the underlying pathology causing breathlessness, the sensation of breathlessness itself must be ameliorated. For many participants there comes a point when there are no further identifiable reversible components of the disease and the full focus of care moves to reducing the subjective sensation of breathlessness. Opioids have been studied for the relief of breathlessness predominantly in people with chronic obstructive pulmonary disease although people with cancer and heart failure have been included. [Abernethy, Miriam Johnson] A meta-analysis verified that overall there is benefit from the use of morphine in people with refractory breathlessness. [Jennings] This prospective, randomised, placebo-controlled, double-blind, cross-over study is modelled on a study successfully undertaken by some members of this research team. The study proposes to specifically study people with primary pulmonary hypertension for whom breathlessness is a significant symptomatic problem to establish whether there is benefit from sustained release morphine, and if so, what magnitude of benefit, and the clinical characteristics of those who are most likely to respond to this intervention. Any toxicity will also be carefully monitored.Study participants will receive either Kapanol 20mg and Coloxyl and Senna 1 to 2 tablets, or kapanol placebo and coloxyl and senna placebo for one week, will receive no intervention medication for the second week then will receive the alternative intervention combination for the third week.