The mainstay of pharmacological management of severe breathlessness is opioids, with morphine being the opioid of choice in the absence of renal impairment.
1112 Opioids should be considered in patients who are severely breathless at rest or on minimal exertion. If the patient is able to take oral medication, immediate release oral morphine can be used (such as 2.5 mg every 4 hours). If the patient is unable to swallow or is drowsy or unconscious morphine can be given parenterally to relieve breathlessness. If the patient remains breathless despite the use of opioids, involvement of a palliative care team should be considered.
The use of continuous parenteral infusions can be useful to ensure a consistent background dose of opioid and enable titration according to symptom severity.
An early case series of 101 hospitalised patients with covid-19 who were referred to palliative care found that opioids were usually effective for palliation of breathlessness,