One capsule, once a day. Now, that’s all it takes to ease the symptoms of chronic breathlessness. Fiona Livy uncovers how the world-first treatment, Kapanol®, works and why it’s set to change the lives of 300,000 Australians.
Take a breath in. Now, take in another on top of that. Slowly exhale only that second breath and then inhale a small breath again. As you continue exhaling and inhaling, your chest tightens, your pulse quickens, you can’t get enough air.
This is how thousands of Australians with chronic breathlessness feel. Every. Single. Day. And it doesn’t take much for that suffocating sensation to set in. Some struggle to walk 100 meters. Others find it difficult to get dressed. Many won’t leave home.
“It's an incredibly frightening experience,” explains Professor of Palliative Medicine David Currow. “Just imagine the times that you've been acutely short of breath – you may have had a bad attack of asthma or a case of pneumonia or you simply had to run so hard that you couldn't catch your breath for the next half hour. What if you weren't able to control that?
“Add onto that the slightest insult – an upper respiratory tract infection, a cold, a flu or a really emotional time where suddenly you’re confronted with things that others take for granted, like crying or laughing. Their worlds shrink and that really creates a social death – they’re not getting out to see their friends and family as much and those friends and family tend to give up seeing them too.
“That's a horrifying and ever-present, incredibly limiting and disabling problem that people experience day in and day out.” Until now.
Kapanol® is the world’s first approved treatment for chronic breathlessness. David says, the once-a-day capsule is “filled with little yellow hundreds and thousands. It dissolves very rapidly in the stomach, in seconds, and each of those little hundreds and thousands has a mechanism that gently releases morphine into the gut, and from the gut into the bloodstream, over the next 24 hours.”
It works by supplementing the body’s own morphine-like chemicals. “When you and I get breathless,” explains David, “we start to make these endorphins to reduce that sensation.” People with chronic breathlessness benefit from augmenting their body’s own processes.
Kapanol® has been available for more than 20 years in Australia for reducing pain and David and his team started their research on Kapanol®’s effect on chronic breathlessness in 1998. However, scientists have known morphine can treat breathing difficulties since the 1800s.
“Morphine was discovered in the first decade of the 19th Century,” explains David. “But, as it was starting to be used much more widely in clinical settings after the Second World War, people also realised that it could cause respiratory depression; it could actually slow your rate of breathing down to a level that was very concerning.
“What we've done,” continues David, “is shift from what was available in the 1950s (which was either a liquid solution you would take by mouth or an injection you could give directly into the bloodstream, the muscle or under the skin) to a formulation that releases just a little bit of morphine right around the clock. So, there aren't the same high peaks, nor are there the same low troughs that patients would get from morphine administered 70 years ago.”
Data already show two out of three patients who use Kapanol® experience clinically significant symptomatic relief. That’s great news for the 70,000 Australians diagnosed with severe chronic breathlessness and the 200,000 Australians with disabling breathlessness. The main causes of which are chronic obstructive pulmonary disease (emphysema), advanced cancer, chronic heart failure and neurodegenerative diseases, like motor neurone disease.
“The other group that is affected,” adds David, “is people late in any life-limiting illness who are starting to lose muscle strength. As you see them losing weight, they’re losing muscle. So they often experience this sort of chronic breathlessness.”
It’s why chronic breathlessness is a condition that will affect most Australians at some point in their lives. As our ‘disease profiles’ change and we become better at treating the illnesses and infections that caused our ancestors’ deaths, David says, “most of us will have warning of our death. Making, chronic breathlessness an area that requires ongoing research.
“Health is not just the absence of disease, it's actually about wellbeing. As physicians, if we have people, particularly with chronic conditions whose wellbeing is impaired on a day-to-day basis, what are we here to do? Our role is to decrease that suffering safely and effectively, and improve everyone's quality of life.”
David Currow is a Professor of Palliative Medicine in the Faculty of Health at UT