Table 1: Opioid dosing and titration schedule

Timetable	Drug and dosage	Dyspnea outcome measure
Week 1		At end of week 1, if dyspnea score on Likert scale ≥ 4 (i.e., dyspnea is somewhat intolerable or completely intolerable), then:
Day 1, 2	Morphine sulfate 0.5 mg twice daily
Day 3, 4	Morphine sulfate 0.5 mg every 4 hours
Day 5, 6, 7	Morphine sulfate 1 mg every 4 hours
Week 2	Morphine sulfate 2 mg every 4 hours	At end of week, if dyspnea score ≥ 4 as above, then:
Week 3	Morphine sulfate 3 mg every 4 hours	At end of week, if dyspnea score ≥ 4 as above, then:
Week 4	Morphine sulfate 5 mg every 4 hours	At end of week, if dyspnea score ≥ 4 as above, then:
Week 5+	Ongoing titration weekly, with increase of 30%–50% in dose based on severity of dyspnea and adverse effects. If persistent intolerable adverse effects develop, revert to previous tolerated dose and re-evaluate in 48 hours. If adverse effects persist, rotate to hydromorphone or taper dose by 50% per day and stop over 72 hours.
Week 6+	Patients who remain on a stable dose of opioid (i.e., have not required titration in the preceding 2 weeks) can switch to a sustained-release preparation.