A patient with end-stage lung disease may develop significant dyspnea which can physical impairment and impact the patient's quality of life.


Patient selection: severe dyspnea that persists despite correction of any contributory factors (anemia, etc)


Dose: 20 mg oral morphine sulphate in the morning as a sustained released formulation



(1) decreased dyspnea

(2) improved sleep



(1) nausea and vomiting

(2) sedation (can be modified by using a lower dose or dosing in the evening)

(3) constipation (can be modified by diet, laxatives and methylnaltrexone)


The use of a low dose, sustained release preparation avoids respiratory depression and hypercapnia.


If the oral route is not available, then parenteral morphine can be used.


Alternative opiates include dihydrocodeine and diamorphine.


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