Can low-dose morphine treat IPF cough?

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Recent findings published in The Lancet Respiratory Medicine demonstrate noticeable cough relief for patients with idiopathic pulmonary fibrosis (IPF) who took a brief course of low-dose controlled-released morphine. 

After two weeks, evidence showed that participants who received the twice-per-day morphine reduced their objective awake cough frequency by 39.4% compared to participants who received the twice-per-day placebo. This was determined by the use of objective digital monitoring. Participants with morphine decreased their average daytime cough frequency to 12.8 coughs per hour from a baseline of 21.6 coughs per hour. Those with placebo remained essentially unchanged from the baseline, with this cohort averaging 20.6 coughs after 14 days.

According to the published results, the highest reported side effects from morphine were constipation (21%) and nausea (14%). Adverse events occurred in 40% of the 43 subjects in the morphine group and 14% of the 42 subjects in the placebo group. The report noted that there was one account of mortality in the placebo group due to underlying IPF. 

The PAciFy Cough study was led by Zhe Wu, MD, at the National Heart and Lung Institute at Imperial College in London, UK. He and his research team conducted the phase 2 placebo-controlled, double-blind crossover trial to evaluate the efficacy and safety of using morphine as an antitussive therapy for IPF. Prior to the study, there were no approved, evidence-based treatments available for chronic cough in IPF patients.

"There is a large unmet need for treatments that improve quality of life in individuals with IPF and address highly prevalent and frequently disabling symptoms like cough," wrote Dr. Wu and team. "Insufficient clarity about the pathogenic mechanisms driving cough in IPF has limited the therapeutic options available to patients and clinicians."

Researchers enrolled participants who indicated moderately impaired lung function caused by IPF in the study between December 2020 and March 2023, randomly assigning individuals to cohorts. The patient makeup was 91% white and 70% male with an average age of 71 years.

The investigators noted the potential for addiction and withdrawal caused by opioid use, acknowledging that although the application of low-dose controlled-release morphine demonstrated the endpoint within a short-term timeframe, larger studies with more diverse populations are needed to test the long-term effectiveness and safety of the drug. 

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