Foral Pamela A, Malesker Mark A, Huerta Guillermo, Hilleman Daniel E
Creighton University School of Pharmacy and Health Professions, 2500 California Plaza, Omaha, NE 68178, USA.
Chest. 2004 Feb;125(2):691-4. doi: 10.1378/chest.125.2.691.
To evaluate the role of nebulized opioids in COPD.
A MEDLINE search was completed to obtain pertinent clinical literature. Key search terms included the following: nebulizer, opioids, COPD, dyspnea, morphine, and hydromorphone.
Currently, the evidence in the literature is lacking regarding placebo-controlled studies to support nebulized morphine for the relief of dyspnea in patients with COPD. The studies reviewed varied considerably in the dose, opioid used, administration schedule, and methodology. One study found improved exercise capacity in 11 patients not reproducible in a larger sample, and another study found benefit in 54 terminal patients. All other studies found no benefit.
The recently published Global Initiative for Lung Disease guidelines have specifically stated that opioids are contraindicated in COPD management due to the potential respiratory depression and worsening hypercapnia. Nebulized opioids should be discouraged, as current data do not support their use.
评估雾化吸入阿片类药物在慢性阻塞性肺疾病（COPD）中的作用。
完成了一项医学文献数据库（MEDLINE）检索以获取相关临床文献。关键检索词包括：雾化器、阿片类药物、COPD、呼吸困难、吗啡和氢吗啡酮。
目前，文献中缺乏关于支持雾化吸入吗啡缓解COPD患者呼吸困难的安慰剂对照研究证据。所综述的研究在剂量、使用的阿片类药物、给药方案和方法上差异很大。一项研究发现11例患者运动能力有所改善，但在更大样本中未得到重复，另一项研究发现54例终末期患者从中获益。所有其他研究均未发现有益效果。
最近发布的慢性阻塞性肺疾病全球倡议（Global Initiative for Lung Disease）指南明确指出，由于潜在的呼吸抑制和高碳酸血症加重，阿片类药物在COPD管理中是禁忌的。应不鼓励使用雾化吸入阿片类药物，因为目前的数据不支持其使用。
