Opioids for Breathlessness: A Podcast with David Currow
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
43 min
5 speakers
8 chapters
transcribed 6 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is the central question about opioids and breathlessness that the episode explores?
The Jerry Powell Podcast is brought to you by Archstone Foundation, preparing society and meeting the needs of an aging population. And now, here are your hosts. Welcome to the Jerry Powell Podcast. This is Eric Guadera. This is Alex Smith.
And this is Lynn Flint.
Alex, we have somebody very, very, very special. We have a
world famous palliative care researcher. We have Professor David Currow, who is from the University of Technology, Sydney, Australia, who is actually in Hull, England, visiting a collaborator right now who joins us on the Skype line. Thank you so much for joining us, David.
Great to be with you. So we're going to be talking about breathlessness, managing things like dyspnea and palliative care populations. And we're going to be talking about one of David's recent articles in Thorax about sustained release morphine for chronic breathlessness. But before we do, we always start off with a song request. David, do you have a song request for Alex?
Well, every breath you take by the police has to be today's song request, really, doesn't
it? That's perfect.
Every breath you take and every move you make, every bond you break, every cake you bake, I'll be watching you. Cake you bake. You didn't know that? I didn't know. You didn't know that part? You love that. I love that. I
was practicing
a
song last night and my younger son says, what is that song about? Is that about Santa Claus? Like, I'll be watching you all the time.
It's a little creepy.
It's very creepy. It's a creepy song. But we're not going to be talking about the creepiness aspect of it. We're going to be talking about the breathlessness aspect of it. And David, I'm really excited. So for those listeners who don't know, you've done some really pivotal studies, often maybe turning around a little bit about what we do in palliative care. So... Oxygen for everybody with breathlessness. Maybe that doesn't work. Octreotide for individuals with malignant bowel obstruction. Maybe that doesn't work. Antipsychotics with Mira Agar. Maybe that doesn't work for delirium and palliative care populations. And now opioids. Wait, before we actually talk about like Do opioids work for breathlessness in palliative care populations?
How did you get kind of interested in this as a subject?
Look, I think breathlessness has been a Cinderella topic for a long time. And, you know, if we wind the clock back 40 years, when someone came in with cancer and said, I've got pain, their clinician said, well, of course you do. You've got cancer. And unfortunately, we still do exactly the same when someone comes in and says, I'm breathless. People shrug their shoulders and go, well, you've got chronic obstructive pulmonary disease. What do you expect? Rather than saying, how do we deal with the symptom, particularly of chronic breathlessness, breathlessness that is unremitting? And so that's what I've been working on with a team really right around the world over the last few years.
I want to sort of dive into talking about why this particular study was needed. And in our clinical practice, when I'm seeing somebody with breathlessness, I first will suggest non-pharmacologic interventions, but often those are insufficient, at least for the severity of patients I'm seeing. And to be fair, I see patients who are hospitalized and they tend to have very severe breathlessness. And so I will prescribe opioids and sometimes long-acting opioids. I'm interested in your sense of whether this is sort of standard practice that this article is evaluating and potentially challenging here.
How did David Currow become interested in researching opioids for chronic breathlessness?
So as you point out, you know, we have a responsibility to make sure that the reversible things are reversed and, you know, that paper by Deb Dudgeon 20 years ago suggests that we shouldn't assume that everyone else has looked for the reversible causes. The non-pharmacological therapies are crucial. And really, as you move to pharmacological therapies, we have statements from the American College of Physicians, the American College of Chest Physicians, the Canadian Thoracic Society, the European Respiratory Society, suggesting that opioids have a role.
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Chapters
8 chapters
1
What is the central question about opioids and breathlessness that the episode explores?
0:01–4:33
2
How did David Currow become interested in researching opioids for chronic breathlessness?
4:33–10:25
3
What were the design features and inclusion criteria of the Thorax sustained‑release morphine trial?
10:25–16:07
4
Why did the study allow immediate‑release morphine rescue medication for all participants?
16:07–21:45
5
What did the primary outcome (breathlessness now) reveal about morphine versus placebo?
21:45–27:39
6
How did secondary analyses (worst breathlessness, disease sub‑groups) influence the interpretation of results?
27:39–34:22
7
What are the safety findings—especially regarding constipation, nausea, and respiratory depression—in long‑acting morphine for breathlessness?
34:22–38:29
8
What practical guidance does the episode give for clinicians using short‑acting versus long‑acting opioids in palliative care?
38:29–43:47
Speakers
5 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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