Opioid Safety in COPD Breathlessness — SCE Palliative Medicine MCQ

Correct answer: D — At low doses for breathlessness (5–30 mg oral morphine/24 hr), the risk of clinically significant respiratory depression is very low; multiple studies have not shown increased respiratory complications

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

Answer: C NICE (UK) guidance (NG115) supports use of opioids for refractory breathlessness in end‑stage COPD when other treatments have failed ([nice.org.uk](https://www.nice.org.uk/guidance/ng115/chapter/Recommendations?utm_source=openai)). A high‑quality systematic review (271 patients, mostly with severe COPD) demonstrated that systemic opioids reduce breathlessness without serious adverse effects or clinically significant respiratory depression ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/25803110/?utm_source=openai)). UK palliative care guidance further affirms that initiating low doses and titrating carefully is safe and does not meaningfully impair respiratory function ([rightdecisions.scot.nhs.uk](https://www.rightdecisions.scot.nhs.uk/media/3r2dw5rx/the-management-of-breathlessness-in-palliative-care.pdf?utm_source=openai)). Distractors: A and D reflect unfounded fears; evidence shows low‑dose opioids can be safely used. B is incorrect—codeine is not preferred and lacks evidence advantage. E is misleading: nebulised opioids have low‑quality, inconsistent evidence and are not considered safer than oral—systemic opioids have better evidence base ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/25803110/?utm_source=openai)).

Reference: NICE NG115 (2019) – use of opioids in end‑stage COPD; Magnus Ekström et al. systematic review (2015) – systemic opioids improve breathlessness without serious respiratory depression; Scottish palliative care guidance – low‑dose titration safe (2026). https://www.nice.org.uk/guidance/ng115/chapter/Recommendations#palliative-care