Chest
Volume 104, Issue 1, July 1993, Pages 175-178
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Clinical Investigations
Effects of Nebulized Morphine Sulfate on the Exercise Tolerance of the Ventilatory Limited COPD Patient

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We have shown previously that the administration of morphine (0.8 mg/kg) to patients with COPD increases the V˙o2max by 19.3 percent. A recent study demonstrated that the administration of low-dose nebulized morphine (~2 mg) increased the endurance time of patients with severe lung disease by 1 min (35 percent) with few systemic side effects. This double-blind crossover study evaluated the effects of various doses of nebulized morphine (0, 1, 4, and 10 mg) on the exercise tolerance and the psychologic status of COPD patients. In the present study, eight COPD patients (FEV1=0.90±0.26 L, workload max = 76±29 W, V˙o2max = 950±264 ml, V˙Emax=34±7 L), who were ventilatory limited were tested on four separate days. On each testing day, the patients underwent incremental exercise testing and psychologic testing before and 45 min after receiving the nebulized solution. The mean changes (±SD) in the exercise test results after each of the four different regimens were as follows:

Empty CellWorkload, Wo2max, ml/minEmax, L/min
Placebo0.6±6.8-11±86-1.9±3.0
1 mg-0.6±7.7-29±58-1.8±2.0
4 mg1.8±7.517±141-1.4±4.6
10 mg5.6±6.263±1011.9±5.1
Although there tended to be larger increases in the workload, V˙o2max, and VEmax after the largest dose of morphine, none of the changes was statistically significant. Likewise, there were no significant differences in spirometry, resting metabolic measurements, or psychologic test scores after the four different regimens. We conclude that aerosolized morphine in the doses used in this study has no significant beneficial effect on the exercise tolerance of patients with COPD.

Section snippets

Ritient Selection

Eight COPD patients were studied. Inclusion criteria for the study included an FEV1 below 1.4 L, FEV1/FVC below 0.50, exercise limited by breathlessness, and a stable disease state. Patients were excluded if they met any of the following criteria: (1) PaCO2 above 45 mm Hg; (2) long-term oxygen therapy; (3) known cardiac disease, including left ventricular dysfunction, previous myocardial infarction, angina pectoris, arrhythmias requiring pharmacologic therapy, or hypertension requiring more

Results

The characteristics of the seven male patients and one female patient who completed the protocol are shown in Table 1. The average patient was elderly with severe COPD. The exercise capability was severely reduced with a mean V˙o2max of 950±264 ml/min and a mean maximal workload of less than 80 W. The patients appeared to be ventilatory limited since the mean V˙Emax/FEV1 was 39.4, the mean R increased only 0.07 from rest to Emax, the mean Borg score at Emax was 8.4±2.2, and the mean

Discussion

This present study demonstrates that the administration of 1 to 10 mg of morphine sulfate by a nebulizer does not have a significant effect on the exercise tolerance of patients who are ventilatory limited from COPD. There is a tendency for the exercise tolerance to increase with the largest dose. Since the mental function is not affected by this dose and there were no other discernible side effects, additional studies with larger doses of aerosolized opiates may be warranted.

Previous studies

References (14)

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Presented in part at the Annual Meeting, American Thoracic Society, Anaheim, Calif, May 1991.

Supported in part by the Research Service of the Department of Veterans Affairs.

Manuscript received August 18, revision November 23.

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