Morphine has shown promise as an effective cough therapy for pulmonary fibrosis, according to recent studies. A multicenter, double-blind, placebo-controlled, crossover trial of low-dose morphine sulfate for the treatment of cough in idiopathic pulmonary fibrosis (IPF) called PAciFy Cough was conducted, and it showed favorable outcomes for morphine as a treatment for IPF-related cough. Longer-term studies are needed to explore optimal dosing and adjunctive antitussive therapies in IPF [1, 2, 3].
Background:
- IPF is a progressive lung disease with cough as a major symptom.
- No cure exists, and current treatments only manage symptoms and slow progression.
- Severe chronic cough significantly impacts quality of life and may worsen disease progression.
- Opioids like morphine are used for cough and dyspnea (breathlessness) in IPF.
Morphine is a non-synthetic narcotic derived from opium that is used for the treatment of pain. It belongs to the group of medicines called narcotic analgesics and acts on the central nervous system to relieve pain. Morphine is marketed under generic and brand name products, including MS-Contin, Oramorph SR, MSIR, Roxanol, Kadian, and RMS. It is available in various forms, including oral solutions, immediate-release and extended-release tablets and capsules, and injectable preparations. Morphine has a high potential for abuse and is a Schedule II narcotic under the Controlled Substances Act. Its effects include euphoria and relief of pain, and chronic use of morphine results in tolerance and physical and psychological dependence. Morphine can potentially be a lethal medication when not used properly, and patients taking morphine should avoid any other substances that could cause additional opioids, benzodiazepines, and barbiturates
What is pulmonary fibrosis?
Pulmonary fibrosis is a serious lung disease characterized by the thickening and scarring of lung tissue, which makes it harder for the lungs to function properly. This scarring can be caused by various factors such as exposure to pollutants, certain medications, genetic factors, and in some cases, the cause is unknown, which is referred to as idiopathic pulmonary fibrosis (IPF). The condition leads to symptoms such as shortness of breath and a chronic dry cough. Unfortunately, lung damage due to pulmonary fibrosis is permanent and irreversible. While there is no cure, treatments and medications can help slow down the scarring and manage symptoms to improve the patient’s quality of life. In some cases, a lung transplant may be appropriate. Pulmonary fibrosis is considered a progressive and terminal illness, ultimately leading to death.
The Study
- Researchers compared the effectiveness of low-dose controlled-release morphine and placebo in IPF patients with chronic cough.
- The double-blind, randomized, crossover trial (PACIFY COUGH) involved three UK centers specializing in interstitial lung disease.
- Participants were aged 40-90, diagnosed with IPF within the past five years, and had severe chronic cough for over eight weeks.
- Cough severity was assessed using a visual analog scale, with ≥30 mm considered eligible (indicating significantly lower quality of life).
- Lung function tests and CT scans were performed to confirm IPF and exclude emphysema or conditions preventing morphine use.
- Patients were randomly assigned to receive either morphine or placebo in period one, with treatments switched in period two.
- The primary outcome was the change in daytime cough frequency compared to baseline.
- Patient-reported changes in cough, dyspnea, depression, and IPF were secondary outcomes.
Results:
- Morphine significantly reduced objective cough counts compared to placebo after two weeks (39.4% reduction).
- Daytime cough frequency decreased from 21.6 coughs per hour at baseline to 12.8 coughs per hour with morphine, with no similar change in the placebo group.
- 40% of participants experienced adverse reactions with morphine, compared to 14% with placebo.
- Side effects with morphine were mainly constipation and nausea, while the placebo group had one case of death.
Conclusions:
- Low-dose controlled-release morphine significantly reduces cough in IPF patients.
- More studies are needed to assess long-term safety profiles.
- The substantial impact of cough on life justifies morphine use as a short-term symptom management option in IPF patients.
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