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积极识别和管理慢性难治性呼吸困难是一项人权。

The active identification and management of chronic refractory breathlessness is a human right.

机构信息

Discipline, Palliative and Supportive Services, Flinders University, , Adelaide, Australia.

出版信息

Thorax. 2014 Apr;69(4):393-4. doi: 10.1136/thoraxjnl-2013-204701. Epub 2013 Nov 8.

Abstract

Chronic refractory breathlessness is defined as breathlessness at rest or on minimal exertion that will persist chronically despite optimal treatment of the underlying cause(s). At any time, 1% of the population report a modified Medical Research Council dyspnoea score of ≥ 3 chronically. Despite the prevalence, severity and chronicity of this symptom and an evidence base of affordable and safe interventions, chronic refractory breathlessness remains grossly undertreated. Many patients and clinicians accept the presence of the chronic refractory breathlessness as an inevitable part of an illness, with no thought of treating the symptom despite an evidence base for its safe treatment. Consensus statements from major respiratory clinician organisations now endorse such a clinical course. Failure to inquire about, assess and properly treat chronic refractory breathlessness with opioids as outlined in specialist clinical guidelines is now an unacceptable level of care ethically and is, arguably, a breach of people's human rights. Adequate pain control through access to pain relief is now accepted as a human right and, given its burden across the world, the symptomatic treatment of chronic refractory breathlessness should be seen in exactly the same way.

摘要

慢性难治性呼吸困难定义为在休息或轻微活动时出现的呼吸困难,尽管对潜在病因进行了最佳治疗,但仍会持续存在。在任何时候,有 1%的人口报告存在慢性改良医学研究理事会呼吸困难评分≥3 的情况。尽管这种症状普遍存在、严重且具有慢性特征,并且有负担得起且安全的干预措施的证据基础,但慢性难治性呼吸困难的治疗仍然严重不足。许多患者和临床医生接受慢性难治性呼吸困难的存在是疾病不可避免的一部分,尽管有针对该症状的安全治疗证据,但他们并没有考虑治疗该症状。主要呼吸临床医生组织的共识声明现在认可这种临床病程。现在,不按照专家临床指南中概述的那样询问、评估和适当使用阿片类药物治疗慢性难治性呼吸困难,在道德上是不可接受的,而且可以说是侵犯了人们的人权。现在,通过获得止痛缓解来充分控制疼痛被认为是一项人权,考虑到它在全球的负担,慢性难治性呼吸困难的症状治疗应该以完全相同的方式看待。

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