Battaglia S, Bezzi M, Sferrazza Papa G F
Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, University of Palermo, Palermo, Italy -
Minerva Med. 2014 Dec;105(6 Suppl 3):1-7. Epub 2015 Jan 14.
Breathlessness is a key symptom in chronic obstructive pulmonary disease (COPD) with prognostic implications on health status and survival. Since most conditions underlying chronic refractory breathlessness in COPD are not modifiable, the use of opioids and benzodiazepines has been proposed to relieve it. However, respiratory depression is a known adverse event of these drugs, and concerns have been raised on their use in patients with chronic respiratory failure. Despite safety-related concerns, benzodiazepines are frequently prescribed for a variety of reasons, including treatment of insomnia, depression and anxiety, as well as to relieve refractory dyspnea in patients with COPD. The key role of opioids in the end-of-life and in the management of dyspnea that is unresponsive to best-possible disease management is recognized. Moreover, the use of low dose opioids to treat dyspnea, discomfort or refusal for patient undergoing non-invasive ventilation is still debated. In the current review, we aim at discussing and analyzing recently published findings on the use of benzodiazepines and opioids in patients with COPD and at reviewing the literature on this topic. Recent observations favor the use of lower doses of opioids (≤30 mg oral morphine equivalents/day) for reduction of symptoms in those patients with severe COPD receiving long-term oxygen therapy. Low dose opioids are not associated with an increased risk of hospital admission or death in cohorts of COPD patients on long term oxygen therapy. On the contrary, benzodiazepines and opioids at higher doses might increase mortality.
呼吸困难是慢性阻塞性肺疾病（COPD）的关键症状，对健康状况和生存率具有预后意义。由于COPD中慢性难治性呼吸困难的大多数潜在病因无法改变，因此有人提议使用阿片类药物和苯二氮䓬类药物来缓解症状。然而，呼吸抑制是这些药物已知的不良事件，人们对其在慢性呼吸衰竭患者中的使用表示担忧。尽管存在与安全相关的担忧，但苯二氮䓬类药物因各种原因经常被处方，包括治疗失眠、抑郁和焦虑，以及缓解COPD患者的难治性呼吸困难。阿片类药物在临终关怀以及对最佳疾病管理无反应的呼吸困难管理中的关键作用已得到认可。此外，使用低剂量阿片类药物治疗接受无创通气患者的呼吸困难、不适或拒绝治疗仍存在争议。在当前的综述中，我们旨在讨论和分析最近发表的关于在COPD患者中使用苯二氮䓬类药物和阿片类药物的研究结果，并回顾关于该主题的文献。最近的观察结果支持在接受长期氧疗的重度COPD患者中使用较低剂量的阿片类药物（≤30毫克口服吗啡当量/天）来减轻症状。在长期接受氧疗的COPD患者队列中，低剂量阿片类药物与住院或死亡风险增加无关。相反，高剂量的苯二氮䓬类药物和阿片类药物可能会增加死亡率。
