O'Donnell Denis E, Webb Katherine A, Harle Ingrid, Neder J Alberto
a Department of Medicine , Queen's University & Kingston General Hospital , Kingston , ON , Canada.
Expert Rev Respir Med. 2016 Jul;10(7):823-34. doi: 10.1080/17476348.2016.1182867. Epub 2016 May 12.
Activity-related breathlessness is often the dominant symptom in patients with chronic obstructive pulmonary disease (COPD) and usually persists despite optimal medical therapy. Currently, our inability to meaningfully alter the pathophysiology of the underlying disease means that we must focus our attention on relieving this distressing symptom so as to improve exercise tolerance and quality of life.
The current review examines the neurobiology of breathlessness and constructs a solid physiological rationale for amelioration of this distressing symptom. We will examine the efficacy of interventions which: 1) reduce the increased central drive to breathe (opioids); 2) improve the respiratory system's ability to appropriately respond to this increased demand (bronchodilators); and 3) address the important affective dimension of breathlessness (anxiolytics). Expert commentary: Advances in our understanding of the mechanisms of activity-related breathlessness in COPD, and its measurement in the clinical domain, now set the stage for the development of effective management strategies on an individual patient basis.
与活动相关的呼吸困难通常是慢性阻塞性肺疾病（COPD）患者的主要症状，并且即便接受了最佳药物治疗，该症状通常仍会持续。目前，我们无法有效改变潜在疾病的病理生理状况，这意味着我们必须将注意力集中在缓解这一令人痛苦的症状上，以提高运动耐量和生活质量。
本综述探讨了呼吸困难的神经生物学，并为缓解这一令人痛苦的症状构建了坚实的生理学依据。我们将研究以下干预措施的疗效：1）降低增加的呼吸中枢驱动（阿片类药物）；2）提高呼吸系统对这种增加需求的适当反应能力（支气管扩张剂）；3）解决呼吸困难的重要情感维度问题（抗焦虑药）。专家评论：我们对COPD中与活动相关的呼吸困难机制及其在临床领域测量方法的理解取得了进展，这为基于个体患者制定有效的管理策略奠定了基础。
