Evidence map›Paper›PMID 12958109›Full record

Trial reportBMJ (Clinical research ed.)2003

Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea.

Amy P Abernethy, David C Currow, Peter Frith, Belinda S Fazekas, Annie McHugh, Chuong Bui

3 registry-linked trialsOpen access · bronzeAbstract readClinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 111 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
111citing papers in PubMed, 14 pooled it
10.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03834363 phase4completednot on this mapstarted 2019, after this paper: background citation

Morphine or Fentanyl for Refractory Dyspnea in COPD

TypeinterventionalSponsorHuib A.M. KerstjensRan2019 to 2024Enrolled59ConditionsCOPDArmsFentanyl, Morphine Retard, Placebo patch, Placebo oral capsule
NCT04815317 nacompletednot on this mapstarted 2019, after this paper: background citation

Sensory and Emotional Modulation of Dyspnea Under Artificial Ventilation in the Intensive Care Unit

TypeinterventionalSponsorAssociation pour le Développement et l'Organisation de la Recherche en Pneumologie et sur le SommeilRan2019 to 2021Enrolled45ConditionsDyspneaArmsAuditive stimulation, Sensitive stimulation, Auditory control, Sensitive control
NCT07498816 narecruitingnot on this mapstarted 2025, after this paper: background citation

Impact of Immersive Virtual Reality (IVR) on Respiratory Effort: A Pilot Study in Healthy Adults

TypeinterventionalSponsorPontificia Universidad Catolica de ChileRan2025 to 2026Enrolled10ConditionsVirtual Reality, Respiratory Effort, ExerciseArmsImmersive Virtual Reality
3 · Its place in the literature

Who cites it

111 citing papers in PubMed, 14 syntheses or guidelines pooled it, 516 citations in OpenAlex.

  1. Guideline
  2. Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2024
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Medically assisted hydration for adult palliative care patients.The Cochrane database of systematic reviews · 2014
    Pooled it
  8. Shortness of breath and cough in patients in palliative care.Deutsches Arzteblatt international · 2013
    Pooled it
  9. Pooled it
  10. Guideline
  11. Blood transfusions for anaemia in patients with advanced cancer.The Cochrane database of systematic reviews · 2012
    Pooled it
  12. The management of dyspnea in cancer patients: a systematic review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2008
    Guideline
  13. Pooled it
  14. Guideline
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

51 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Amy P AbernethyDepartment of Palliative and Supportive Services, Division of Medicine, Flinders University of South Australia, Bedford Park, South Australia 5042, Australia.
David C Currow
Peter Frith
Belinda S Fazekas
Annie McHugh
Chuong Bui
Repatriation General Hospital · AUFlinders University · AUNepean Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated.

designRandomised, double blind, placebo controlled crossover study.

settingFour outpatient clinics at a hospital in South Australia.

participants48 participants who had not previously been treated with opioids (mean age 76, SD 5) with predominantly chronic obstructive pulmonary disease (42, 88%) were randomised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo, or vice versa. Laxatives were provided as needed.

main outcome measuresDyspnoea in the morning and evening as shown on a 100 mm visual analogue scale, quality of sleep, wellbeing, performance on physical exertion, and side effects as measured at the end of the four day treatment period.

results38 participants completed the study; three withdrew because of definite and two because of possible side effects of morphine (nausea, vomiting, and sedation). Participants reported significantly different dyspnoea scores when treated with morphine: an improvement of 6.6 mm (95% confidence interval 1.6 mm to 11.6 mm) in the morning and of 9.5 mm (3.0 mm to 16.1 mm) in the evening (P = 0.011 and P = 0.006, respectively). During the period in which they were taking morphine participants also reported better sleep (P = 0.039). More participants reported distressing constipation while taking morphine (9 v 1, P = 0.021) in spite of using laxatives. All other side effects were not significantly worse with morphine, although the study was not powered to address side effects.

conclusionsSustained release, oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting.

Indexed as

Administration, OralAgedChronic DiseaseCross-Over StudiesDelayed-Action PreparationsDouble-Blind MethodDyspneaFemaleHumansMaleMorphineNarcoticsPulmonary Disease, Chronic ObstructiveDelayed-Action PreparationsMorphineNarcotics

Identifiers

PMID12958109
PMCPMC192892
OpenAlexW2157851934

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.