Nebulized morphine for intractable cough in advanced cancer: two case reports.


BACKGROUND Cough is a distressing symptom in advanced cancer. Opioids are used to relieve respiratory symptoms including dyspnea and cough. In addition to a central mechanism, opioids are thought to work peripherally via opioid receptors of the lung. Therefore, direct inhalation of morphine has been investigated in chronic lung disease or cancer. We report our experience of a nebulized form of morphine to control intractable cough in patients with advanced cancer. METHODS AND RESULTS Case 1 is a 63-year-old female with terminal lung cancer complaining of a severe dry cough with dyspnea and sleeplessness. Case 2 is a 53-year-old female with thymic carcinoma with multiple lung metastases suffering from severe cough accompanying chest pain and dyspnea. With usual treatment, cough did not improve in these patients. We then administered a nebulized form of morphine: hydrochloro-morphine 5 mg mixed with 3 mL normal saline inhaled by mouth using a nebulizer. When the morphine dose was increased to 10 mg and 15 mg, the patients' cough was relieved to a symptom level of moderate and mild, respectively. Without experiencing any severe systemic side effects of opioids, the patients continued nebulized morphine until death or discharge. CONCLUSION Nebulized morphine was effective in controlling intractable cough due to cancer and it was convenient and safe.

DOI: 10.1089/jpm.2014.0126

Cite this paper

@article{An2015NebulizedMF, title={Nebulized morphine for intractable cough in advanced cancer: two case reports.}, author={Ho Jung An and Il-Kyu Kim and Jung Eun Lee and Yi-Jin Kang and Chi Hong Kim and Hoon-Kyo Kim}, journal={Journal of palliative medicine}, year={2015}, volume={18 3}, pages={278-81} }