How to time Morphine and nebulizer in COPD treatment?

Question

Hello doctor,

I am a 68-year-old male. I have lung emphysema, end-stage chronic obstructive pulmonary disease (COPD) diagnosed as stage III. I had a heart operation (stent) the previous year, and had signs of heart failure for four months. My symptoms are breathlessness on lying down supine, particularly at night. When waking up at night, it is beginning to border on respiratory failure. I am currently on Morphine solution 2 % and Ventolin. Would it be advisable to use Morphine and then a nebulizer immediately? Would a bilevel positive airway pressure (BiPAP) machine be useful?

Kindly guide.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

According to your statement, you have been suffering from breathlessness while lying down supine, particularly at night. Dyspnea resulting from complications due to end-stage diseases like end-stage COPD (chronic obstructive pulmonary disease) is often treated with an opioid-like morphine nebulizer. Dyspnea can cause discomfort and worry to patients. Inhalation of opioid-like Morphine can provide psychological support. Limited research has been done regarding using a nebulizer with Morphine in managing patients with COPD and other respiratory diseases, and the results are conflicting. Opioids can also cause respiratory depression. Its use in patients with COPD or any other respiratory problems may be fatal and life-threatening. Without consulting with a pulmonologist, such a type of opioid medication should not be used. A bilevel positive airway pressure (BiPAP) machine is very useful and effective for COPD patients. It may provide two different air pressure types that help lessen the work it takes to breathe, which is important in people with COPD who expend a lot of energy breathing.

I hope this helps.

Regards.

Answer 2

Hi,

Welcome back to icliniq.com.

I have already mentioned that usually, a Morphine solution can be used before using a nebulizer with Ventolin. Morphine can cause respiratory difficulties, and Ventolin can prevent bronchospasm and respiratory difficulties. So if Morphine is used before using a nebulizer with Ventolin, it may help prevent morphine-induced respiratory difficulties. But as I have mentioned earlier, limited studies have been done regarding using Morphine before a nebulizer with Ventolin in patients with chronic obstructive pulmonary disease (COPD) and other respiratory diseases, and the results are conflicting. So, the whole things depend on your pulmonologist's advice and your health conditions. Using Morphine via nebulization before using bronchodilator medications with a nebulizer can be used according to studies, but it may be fatal for some patients.

I hope this helps.

Regards.