A qualitative exploration of women's experiences, stigma, and access to care in gaming disorder.

Dyspnoea is one of the most prevalent and burdensome symptoms in patients with advanced COPD, affecting up to 94% of individuals in the final years of life [, ]. Dyspnoea is considered persistent when the symptom persists despite optimal standard care []. It significantly impairs health-related quality of life, limits physical activity, and is associated with anxiety and depression. Furthermore, persistent dyspnoea not only impacts the life of patients, but also of their loved ones []. Since the number of patients with COPD worldwide is still increasing, there will be an increasing number of patients suffering from persistent dyspnoea caused by COPD. This underscores an urgent clinical need for effective and accessible therapeutic options to alleviate the distress associated with persistent dyspnoea. Advanced therapeutic options, including pulmonary rehabilitation, non-invasive ventilation, lung volume reduction treatments and lung transplantation, can improve dyspnoea and quality of life in patients with severe COPD []. However, due to strict eligibility criteria, high healthcare costs, varying availability and in some cases scarcity, these treatments are not available for a large proportion of patients with advanced COPD. This underlines the need for a widely available, preferably low-cost, treatment for persistent dyspnoea in COPD. Low-dose opioids have been investigated for persistent dyspnoea, and some studies have demonstrated a positive effect of opioids on dyspnoea [–]. This treatment option has therefore made its way into several guidelines, among which the Dutch guideline for palliative care in COPD []. Nevertheless, concerns persist regarding the clinical significance of the observed effects, as well as the potential for adverse events associated with opioid use.