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Opioid for breathlessness — DGM MCQ

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ModerateEnd-of-life careOpioid for breathlessnessDGM

An 84-year-old woman with end-stage COPD has distressing breathlessness despite optimal inhalers and fan therapy. Oxygen saturation is 93% on air and she is anxious about dying breathless. She is not opioid tolerant. Current medicines include salbutamol, tiotropium and sertraline. What is the most appropriate management?

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Correct answer: B — Consider low-dose opioid with monitoring and explanation

Low-dose opioids can reduce refractory breathlessness in palliative care even when oxygen saturation is not severely reduced. Oxygen is not indicated solely for breathlessness without hypoxaemia, avoiding opioids categorically misses benefit, benzodiazepines are not first-line alone, and symptoms need treatment despite acceptable saturation. Breathlessness is subjective and should not be managed by oximetry alone.

Reference: NICE NG31; palliative care guidance