Junior doctors' attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

Intern Med J. 2017 Sep;47(9):1050-1056. doi: 10.1111/imj.13521.


Background: Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off-licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD.

Aims: To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD.

Methods: All junior doctors undertaking basic training in internal medicine in Victoria were invited to complete an online survey. Knowledge, willingness, and experience prescribing opioids to COPD patients with refractory breathlessness, were examined.

Results: Of the 243 responses received, most trainees (193, 86.5%) believed opioids have a role in treating refractory breathlessness in stable COPD outpatients, with 143 (64.1%) recommending morphine as first-line treatment for refractory breathlessness. One quarter (55, 24.7%) reported having themselves initiated an opioid and 102 (45.7%) had prescribed an opioid under senior supervision for management of breathlessness in COPD. Concern regarding adverse opioid effects was low, with 58 (26.0%) having no concerns prescribing an opioid to COPD patients.

Conclusion: This is the first study of doctors to demonstrate high awareness, confidence, willingness and experience in prescribing opioids for the off-licence indication of refractory breathlessness in COPD. These findings differ significantly from attitudes reported overseas and are unexpected given the doctors surveyed were recently qualified. The low awareness of possible adverse events and limited insight regarding knowledge gaps is concerning and highlights the significant need for greater education in palliative care.

Keywords: COPD; attitude; dyspnoea; opioid; survey.

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Attitude of Health Personnel*
  • Clinical Competence*
  • Dyspnea / drug therapy*
  • Dyspnea / epidemiology
  • Female
  • Humans
  • Internship and Residency / trends
  • Male
  • Medical Staff, Hospital / psychology
  • Physicians / psychology*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Surveys and Questionnaires
  • Young Adult


  • Analgesics, Opioid