呼吸系统疾病呼吸困难管理的系统评价综合分析
An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses.
机构信息
Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
出版信息
BMC Pulm Med. 2010 Dec 9;10:63. doi: 10.1186/1471-2466-10-63.
BACKGROUND
Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation.
METHODS
Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms.
RESULTS
In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication.
CONCLUSIONS
More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.
背景
呼吸困难是多种疾病中一种使人虚弱和痛苦的症状，也是一种难以治疗的症状。我们对非恶性疾病中用于呼吸困难的非药物和药物干预的系统综述进行了综合回顾，以确定目前对呼吸困难管理的临床认识，并强调值得进一步研究的有前途的干预措施。
方法
通过电子数据库在 2007 年 7 月至 2009 年 9 月之间检索系统评价。如果研究报告了使用呼吸困难或其他呼吸症状措施的成年参与者的研究，则将综述纳入研究。
结果
共确定了 219 项系统综述，最终综述纳入了 153 项，其中 59 项涉及非药物干预，94 项涉及药物干预。综述涵盖了超过 2000 项试验。大多数系统综述是针对哮喘和 COPD 的干预措施进行的，主要集中在少数几种药物干预措施上，如皮质类固醇和支气管扩张剂，包括β-激动剂。相比之下，其他涉及呼吸困难的疾病很少或没有得到关注，研究继续侧重于药物方法。此外，尽管有许多非药物研究显示出一些希望，特别是对 COPD，但由于 RCT 缺乏高质量证据、样本量小和复制有限，其结论受到限制。
结论
未来应更多地关注除哮喘和 COPD 以外的呼吸系统疾病的呼吸困难管理。此外，药物治疗并不能完全缓解呼吸困难，而且还会增加副作用的负担。因此，重要的是要更加关注有前途的非药物干预措施。
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