Nebulized medications for the treatment of dyspnea: A literature review

Jackelyn Y. Boyden, Stephen R. Connor, Lily Otolorin, Steven D. Nathan, Perry G. Fine, Malene S. Davis, J. Cameron Muir

Research output: Contribution to journalArticle

Abstract

Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized. This article presents a review of the literature on the use of nebulized medications for the treatment of dyspnea related to cancer, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, or experimentally-induced dyspnea. Methods: A systematic review of peer-reviewed literature was conducted using Medline/PubMed, CINAHL, Cochrane, and Google Scholar. Results: Thirty-nine publications were included in this review, including 17 high-quality clinical research studies, as defined by the GRADE system. The evidence for nebulized morphine remains mixed, whereas a potential benefit was suggested for nebulized furosemide, hydromorphone, and fentanyl. No conclusions could be drawn as to which disease population derived greatest benefit from nebulized medications, or whether jet or ultrasonic nebulizers were more effective for the delivery of these medications. Conclusions: More research is needed to assess the characteristics of specific diseases and the combination of different nebulizers and medications that may yield the greatest benefit, and to assess the safety and efficacy of the chronic use of nebulized opioids and furosemide. Until larger, longer-term studies are completed, the use of nebulized medications to treat dyspnea should be assessed on a case-by-case basis and may be considered if the hoped-for benefits outweigh potential harm.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalJournal of Aerosol Medicine and Pulmonary Drug Delivery
Volume28
Issue number1
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Fingerprint

Dyspnea
Nebulizers and Vaporizers
Furosemide
Opioid Analgesics
Hydromorphone
Peer Review
Interstitial Lung Diseases
Fentanyl
Benzodiazepines
Research
PubMed
Cystic Fibrosis
Ultrasonics
Chronic Obstructive Pulmonary Disease
Morphine
Publications
Quality of Life
Safety
Population
Neoplasms

Keywords

  • advanced lung disease
  • dyspnea
  • nebulized medications
  • nebulized therapies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Pharmacology (medical)
  • Pharmaceutical Science
  • Medicine(all)

Cite this

Boyden, J. Y., Connor, S. R., Otolorin, L., Nathan, S. D., Fine, P. G., Davis, M. S., & Muir, J. C. (2015). Nebulized medications for the treatment of dyspnea: A literature review. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 28(1), 1-19. https://doi.org/10.1089/jamp.2014.1136

Nebulized medications for the treatment of dyspnea : A literature review. / Boyden, Jackelyn Y.; Connor, Stephen R.; Otolorin, Lily; Nathan, Steven D.; Fine, Perry G.; Davis, Malene S.; Muir, J. Cameron.

In: Journal of Aerosol Medicine and Pulmonary Drug Delivery, Vol. 28, No. 1, 01.02.2015, p. 1-19.

Research output: Contribution to journalArticle

Boyden, JY, Connor, SR, Otolorin, L, Nathan, SD, Fine, PG, Davis, MS & Muir, JC 2015, 'Nebulized medications for the treatment of dyspnea: A literature review', Journal of Aerosol Medicine and Pulmonary Drug Delivery, vol. 28, no. 1, pp. 1-19. https://doi.org/10.1089/jamp.2014.1136
Boyden, Jackelyn Y. ; Connor, Stephen R. ; Otolorin, Lily ; Nathan, Steven D. ; Fine, Perry G. ; Davis, Malene S. ; Muir, J. Cameron. / Nebulized medications for the treatment of dyspnea : A literature review. In: Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2015 ; Vol. 28, No. 1. pp. 1-19.
@article{9f31a7b9d9be42789efbe1e3cc767f66,
title = "Nebulized medications for the treatment of dyspnea: A literature review",
abstract = "Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized. This article presents a review of the literature on the use of nebulized medications for the treatment of dyspnea related to cancer, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, or experimentally-induced dyspnea. Methods: A systematic review of peer-reviewed literature was conducted using Medline/PubMed, CINAHL, Cochrane, and Google Scholar. Results: Thirty-nine publications were included in this review, including 17 high-quality clinical research studies, as defined by the GRADE system. The evidence for nebulized morphine remains mixed, whereas a potential benefit was suggested for nebulized furosemide, hydromorphone, and fentanyl. No conclusions could be drawn as to which disease population derived greatest benefit from nebulized medications, or whether jet or ultrasonic nebulizers were more effective for the delivery of these medications. Conclusions: More research is needed to assess the characteristics of specific diseases and the combination of different nebulizers and medications that may yield the greatest benefit, and to assess the safety and efficacy of the chronic use of nebulized opioids and furosemide. Until larger, longer-term studies are completed, the use of nebulized medications to treat dyspnea should be assessed on a case-by-case basis and may be considered if the hoped-for benefits outweigh potential harm.",
keywords = "advanced lung disease, dyspnea, nebulized medications, nebulized therapies",
author = "Boyden, {Jackelyn Y.} and Connor, {Stephen R.} and Lily Otolorin and Nathan, {Steven D.} and Fine, {Perry G.} and Davis, {Malene S.} and Muir, {J. Cameron}",
year = "2015",
month = "2",
day = "1",
doi = "10.1089/jamp.2014.1136",
language = "English (US)",
volume = "28",
pages = "1--19",
journal = "Journal of Aerosol Medicine and Pulmonary Drug Delivery",
issn = "1941-2711",
publisher = "Mary Ann Liebert Inc.",
number = "1",

}

TY - JOUR

T1 - Nebulized medications for the treatment of dyspnea

T2 - A literature review

AU - Boyden, Jackelyn Y.

AU - Connor, Stephen R.

AU - Otolorin, Lily

AU - Nathan, Steven D.

AU - Fine, Perry G.

AU - Davis, Malene S.

AU - Muir, J. Cameron

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized. This article presents a review of the literature on the use of nebulized medications for the treatment of dyspnea related to cancer, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, or experimentally-induced dyspnea. Methods: A systematic review of peer-reviewed literature was conducted using Medline/PubMed, CINAHL, Cochrane, and Google Scholar. Results: Thirty-nine publications were included in this review, including 17 high-quality clinical research studies, as defined by the GRADE system. The evidence for nebulized morphine remains mixed, whereas a potential benefit was suggested for nebulized furosemide, hydromorphone, and fentanyl. No conclusions could be drawn as to which disease population derived greatest benefit from nebulized medications, or whether jet or ultrasonic nebulizers were more effective for the delivery of these medications. Conclusions: More research is needed to assess the characteristics of specific diseases and the combination of different nebulizers and medications that may yield the greatest benefit, and to assess the safety and efficacy of the chronic use of nebulized opioids and furosemide. Until larger, longer-term studies are completed, the use of nebulized medications to treat dyspnea should be assessed on a case-by-case basis and may be considered if the hoped-for benefits outweigh potential harm.

AB - Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized. This article presents a review of the literature on the use of nebulized medications for the treatment of dyspnea related to cancer, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, or experimentally-induced dyspnea. Methods: A systematic review of peer-reviewed literature was conducted using Medline/PubMed, CINAHL, Cochrane, and Google Scholar. Results: Thirty-nine publications were included in this review, including 17 high-quality clinical research studies, as defined by the GRADE system. The evidence for nebulized morphine remains mixed, whereas a potential benefit was suggested for nebulized furosemide, hydromorphone, and fentanyl. No conclusions could be drawn as to which disease population derived greatest benefit from nebulized medications, or whether jet or ultrasonic nebulizers were more effective for the delivery of these medications. Conclusions: More research is needed to assess the characteristics of specific diseases and the combination of different nebulizers and medications that may yield the greatest benefit, and to assess the safety and efficacy of the chronic use of nebulized opioids and furosemide. Until larger, longer-term studies are completed, the use of nebulized medications to treat dyspnea should be assessed on a case-by-case basis and may be considered if the hoped-for benefits outweigh potential harm.

KW - advanced lung disease

KW - dyspnea

KW - nebulized medications

KW - nebulized therapies

UR - http://www.scopus.com/inward/record.url?scp=84922529381&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922529381&partnerID=8YFLogxK

U2 - 10.1089/jamp.2014.1136

DO - 10.1089/jamp.2014.1136

M3 - Article

C2 - 24914770

AN - SCOPUS:84922529381

VL - 28

SP - 1

EP - 19

JO - Journal of Aerosol Medicine and Pulmonary Drug Delivery

JF - Journal of Aerosol Medicine and Pulmonary Drug Delivery

SN - 1941-2711

IS - 1

ER -