The need for greater opioid pharmacovigilance in COPD

hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms Dovepress 189 L e t t e r open access to scientific and medical research Open Access Full text Article Dear editor I read with interest the article by Ahmadi et al 1 that described the use of prescription opioid drugs among Swedes with advanced COPD. The authors are to be commended for their research work on this important clinical topic. I would like to bring to the attention of your readers several points though. First, the authors presented the following striking data: ~50% of individuals with advanced COPD were dispensed opioids and 97% of these dispensings were intended to treat pain. 1 However, several recent Cochrane reviews have concluded that there is insufficient evidence to support the use of opioids for treating chronic musculoskeletal pain. 2–5 I was surprised to see that the authors did not explicitly comment in the discussion on the finding that opioids were frequently used by individuals with advanced COPD for a reason for which there is a lack of supportive evidence. Second, the authors stated that the very low number of opioid dispensings for dysp-nea supports that breathlessness is undertreated in advanced COPD. There may indeed be some truth to this. However, among individuals with COPD dispensed opioids in this study, the vast majority surprisingly had only World Health Organization class 1 (37%) or class 2 (33%) performance status 1 (with class 1 performance status defined as " restricted in physically strenuous activity, but ambulatory and able to carry out work of a light or sedentary nature, eg, light house work and office work " 6). Therefore, another possible explanation for the finding of a very low number of opioid dispensings for dyspnea in this study is that many individuals with advanced COPD in this cohort may have had respiratory symptoms reasonably lessened with more traditional COPD management and the addition of opioids was simply not required. Third, the authors wrote that " the evidence to date supports the safety of low-dose opioids for symptomatic treatment in advanced diseases including COPD ". 1 However, many of the studies they referenced to support this statement were clinical trials specifically designed to evaluate …