Rocker G, Horton R, Currow D, Goodridge D, Young J, Booth S
Division of Respirology, QEII Health Science Centre and Dalhousie University, Halifax Nova Scotia, Canada.
Thorax. 2009 Oct;64(10):910-5. doi: 10.1136/thx.2009.116699.
Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020. The burdens of this increasingly prevalent illness borne by patients, their family caregivers and the healthcare system are substantial. Dyspnoea as the predominant symptom becomes increasingly difficult to palliate as COPD progresses through advanced stages and, for 50% of patients, can become refractory to conventional treatment. This narrative review focuses on the potential role for carefully initiated and titrated opioids in the management of dyspnoea for patients with advanced COPD who are not yet in a terminal stage, yet struggle with symptoms that reflect underlying mechanisms of dyspnoea that lend themselves to this approach. The many barriers that currently exist to the provision of opioids in this setting are addressed, and recommendations are provided for an approach that should engender confidence among patients, their caregivers and the physicians who treat them.
到2020年，慢性阻塞性肺疾病（COPD）将成为全球第三大死因。患者、其家庭护理人员以及医疗系统所承受的这种日益普遍疾病的负担是巨大的。随着COPD进展到晚期，作为主要症状的呼吸困难越来越难以缓解，并且对于50%的患者而言，常规治疗可能会失效。这篇叙述性综述聚焦于谨慎起始和滴定阿片类药物在尚未处于终末期但仍与反映呼吸困难潜在机制的症状作斗争的晚期COPD患者呼吸困难管理中的潜在作用。文中探讨了目前在这种情况下提供阿片类药物存在的诸多障碍，并针对一种应能让患者、其护理人员以及治疗他们的医生产生信心的方法给出了建议。
