Cabezón-Gutiérrez Luis, Khosravi-Shahi Parham, Custodio-Cabello Sara, Muñiz-González Francisco, Cano-Aguirre Maria Del Puerto, Alonso-Viteri Soledad
Medical Oncology Department, Hospital Universitario de Torrejón, Mateo Inurria Street s/n, CP 28850, Torrejón de Ardoz, Madrid, Spain.
Pneumology Department, Hospital Universitario de Torrejón, Madrid, Spain.
Support Care Cancer. 2016 Sep;24(9):4045-55. doi: 10.1007/s00520-016-3316-x. Epub 2016 Jun 22.
Episodic breathlessness (EB) or dyspnea is a common symptom with a very negative impact on the quality of life of patients with cancer and with non-oncological advanced diseases, mainly cardiorespiratory and neurological.
The purpose of this non-systematic review is to ascertain the role played by opioids in the management of episodic breathlessness.
A non-systematic literature review was done in the databases MEDLINE, COCHRANE, and DATABASE, and articles of greater scientific rigor, mainly reviews or prospective studies/randomized clinical trials published to date (August 2015), were selected. Terms used in the search included episodic breathlessness, acute breathlessness, episodic dyspnea, opioids, morphine, fentanyl, oxycodone, and breakthrough dyspnea.
Although the pathophysiology and mechanism of action of opioids for management of breathlessness, and specifically EB, are not fully known, there is scientific evidence, and particularly great clinical evidence, of the benefit of this drug class for dyspnea management. It is important to differentiate hospitalized patients from outpatients because venous or subcutaneous access is easier in hospitalized patients, but use of transmucosal fentanyl, especially in faster formulations like intranasal application, opens up new possibilities to manage outpatients due to its fast onset of action. The main problem is the lack of data available and the multitude of unanswered questions about opioid type, administration route, safety, and dose titration.
发作性呼吸急促（EB）或呼吸困难是一种常见症状，对癌症患者以及患有非肿瘤性晚期疾病（主要是心肺和神经疾病）的患者的生活质量有非常负面的影响。
本非系统性综述的目的是确定阿片类药物在发作性呼吸急促管理中的作用。
在MEDLINE、COCHRANE和DATABASE数据库中进行了非系统性文献综述，并选择了科学性更强的文章，主要是截至2015年8月发表的综述或前瞻性研究/随机临床试验。搜索中使用的术语包括发作性呼吸急促、急性呼吸急促、发作性呼吸困难、阿片类药物、吗啡、芬太尼、羟考酮和突破性呼吸困难。
尽管阿片类药物用于管理呼吸急促，特别是EB的病理生理学和作用机制尚未完全明确，但有科学证据，尤其是大量临床证据表明这类药物对呼吸困难管理有益。区分住院患者和门诊患者很重要，因为住院患者更容易进行静脉或皮下给药，但使用经黏膜芬太尼，尤其是鼻内应用等起效更快的剂型，由于其起效迅速，为管理门诊患者开辟了新的可能性。主要问题是缺乏可用数据以及关于阿片类药物类型、给药途径、安全性和剂量滴定的众多未解答问题。
