Abernethy Amy P, Uronis Hope E, Wheeler Jane L, Currow David C
Division of Medical Oncology, Department of Medicine, Duke University Medical Center (DUMC), Durham, North Carolina 27710, USA.
Wien Med Wochenschr. 2009 Dec;159(23-24):583-90. doi: 10.1007/s10354-009-0727-z.
A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. When dyspnea cannot be relieved by traditional COPD management strategies (i.e., "refractory dyspnea"), the goal of care shifts from prolonged survival to minimized symptoms, improved function, and enhanced quality of life. Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques.
慢性阻塞性肺疾病（COPD）是一种渐进性的使人衰弱的疾病，在全球范围内具有重大影响。除了针对疾病根本原因的治疗外，COPD治疗还包括姑息性干预以解决相关症状；在疾病后期，当基础疾病已得到最大程度治疗时，症状管理成为护理的首要目标。呼吸困难是COPD患者最痛苦的症状。当传统的COPD管理策略无法缓解呼吸困难（即“难治性呼吸困难”）时，护理目标从延长生存期转向减轻症状、改善功能和提高生活质量。有多种药物和非药物干预措施可实现这些目标，但支持证据参差不齐。本综述总结了COPD患者难治性呼吸困难的管理选择，参考现有证据并突出需要进一步研究的领域。主题包括氧气、阿片类药物、精神药物、吸入速尿、氦氧混合气、营养、心理社会支持和呼吸技术。
