Ekström Magnus
Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Curr Opin Support Palliat Care. 2016 Sep;10(3):223-7. doi: 10.1097/SPC.0000000000000220.
To review the findings and methodological strengths and limitations of studies of breathlessness using population-based or routinely collected data, including the novel methodology of the registry-based randomized controlled trial (R-RCT).
Breathlessness severe enough to restrict activity is common and increases in the last months of life both among elderly in the community and among patients in specialized palliative care. During the last week of life, risk factors for more severe breathlessness have been identified. Patients with advanced chronic obstructive or interstitial lung disease experience more breathlessness than patients dying from lung cancer. Breathlessness often remains unrelieved or only partially relieved at the end of life.
Data from population-based or health-administrative databases can inform on the epidemiology, associated factors and the potential impact of breathlessness. Potential strengths of these data are high precision and generalizability because of large, nonselective study populations with high completeness of follow-up of outcomes such as survival. Potential limitations include residual confounding and insufficient data quality which is unaffected by increasing the sample size. The R-RCT methodology combines strengths of randomization with those of large representative databases to evaluate effectiveness in clinical care.
回顾使用基于人群或常规收集的数据进行的呼吸困难研究的结果、方法学优势和局限性，包括基于登记处的随机对照试验（R-RCT）这一新颖方法。
严重到足以限制活动的呼吸困难很常见，在社区老年人和专科姑息治疗患者中，在生命的最后几个月都会增加。在生命的最后一周，已确定了更严重呼吸困难的风险因素。晚期慢性阻塞性或间质性肺疾病患者比死于肺癌的患者经历更多的呼吸困难。呼吸困难在生命结束时往往仍未缓解或仅部分缓解。
基于人群或卫生行政数据库的数据可用于了解呼吸困难的流行病学、相关因素及其潜在影响。这些数据的潜在优势是精度高且具有普遍性，因为研究人群庞大、无选择性，且对生存等结局的随访完整性高。潜在局限性包括残余混杂和数据质量不足，增加样本量对此并无影响。R-RCT方法将随机化的优势与大型代表性数据库的优势相结合，以评估临床护理中的有效性。
