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One evidence base; three stories: do opioids relieve chronic breathlessness?
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  • Published on:
    Opioids for the palliation of breathlessness Cochrane review: additional analyses yield same conclusions
    • Hayley Barnes, Doctor/Researcher Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
    • Other Contributors:
      • Natasha Smallwood, Respiratory Physician/Researcher
      • Julie McDonald, Respiratory Physician/Researcher
      • Renee Manser, Respiratory Physician/Researcher

    We thank Associate Professor Magnus Ekström et al for their research letter regarding our Cochrane Review: Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness (1,2). We also acknowledge that following the publication of their letter in Thorax, feedback was provided through the appropriate mechanism to the Cochrane Review Group (2). We have published a detailed response to their comments in the feedback section of our review, however, given the seriousness of the criticisms published in Thorax, we think it is important that our response also sit alongside their Thorax letter.

    We acknowledge the statistical difficulties in the interpretation and summation of the complex data on opioids for breathlessness. One such issue is the inclusion of crossover studies in a meta-analysis, however, a crossover design is an appropriate way to assess short term interventions, particularly when patient recruitment may be challenging. The Cochrane Handbook outlines several methods to incorporate crossover data into meta-analyses (3). In using the data as if it was a parallel study, the limitations should be acknowledged, in that it can give rise to a unit of analysis error whereby confidence intervals may be wide, and the overall effect is under-estimated. An alternative method is to calculate correlation co-efficients (which describe the ratio of between-patient standard deviation with the within patient variation) to impute...

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    Conflict of Interest:
    None declared.