1 Wolfson Palliative Care Research Centre, Institute for Clinical and Applied Health Research, Hull York Medical School (HYMS), University of Hull, Hull, UK.
2 Community Palliative Care, Withington Community Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
Palliat Med. 2019 Jun;33(6):618-633. doi: 10.1177/0269216319835393. Epub 2019 Mar 8.
Chronic breathlessness is a neglected symptom of advanced diseases.
To examine the effect of airflow for chronic breathlessness relief.
Exploratory systematic review and meta-analysis.
Medline, CINAHL, AMED and Cochrane databases were searched (1985-2018) for observational studies or randomised controlled trials of airflow as intervention or comparator. Selection against predefined inclusion criteria, quality appraisal and data extraction was conducted by two independent reviewers with access to a third for unresolved differences. 'Before and after' breathlessness measures from airflow arms were analysed. Meta-analysis was carried out where possible.
In all, 16 of 78 studies (n = 929) were included: 11 randomised controlled trials of oxygen versus medical air, 4 randomised controlled trials and 1 fan cohort study. Three meta-analyses were possible: (1) Fan at rest in three studies (n = 111) offered significant benefit for breathlessness intensity (0-100 mm visual analogue scale and 0-10 numerical rating scale), mean difference -11.17 (95% confidence intervals (CI) -16.60 to -5.74), p = 0.06 I 64%. (2) Medical air via nasal cannulae at rest in two studies (n = 89) improved breathlessness intensity (visual analogue scale), mean difference -12.0 mm, 95% CI -7.4 to -16.6, p < 0.0001 I = 0%. (3) Medical airflow during a constant load exercise test before and after rehabilitation (n = 29) in two studies improved breathlessness intensity (modified Borg scale, 0-10), mean difference -2.9, 95% CI -3.2 to -2.7, p < 0.0001 I = 0%.
Airflow appears to offer meaningful relief of chronic breathlessness and should be considered as an adjunct treatment in the management of breathlessness.
慢性呼吸困难是晚期疾病中被忽视的症状。
研究气流对慢性呼吸困难缓解的效果。
探索性系统评价和荟萃分析。
在 Medline、CINAHL、AMED 和 Cochrane 数据库中检索（1985-2018 年），纳入关于气流作为干预或对照的观察性研究或随机对照试验。两位独立评审员根据预先设定的纳入标准进行选择、质量评估和数据提取，如果存在分歧则由第三位评审员解决。分析气流组干预前后的呼吸困难测量值。如果可能，进行荟萃分析。
共纳入 78 项研究中的 16 项（n=929）：11 项氧气与医用空气的随机对照试验、4 项随机对照试验和 1 项风扇队列研究。共进行了 3 项荟萃分析：（1）3 项研究中风扇在休息时（n=111）对呼吸困难强度（0-100mm 视觉模拟量表和 0-10 数字评定量表）有显著益处，平均差值-11.17（95%置信区间（CI）-16.60 至-5.74），p=0.06 I 64%。（2）在 2 项研究中，休息时经鼻导管给予医用空气（n=89）改善呼吸困难强度（视觉模拟量表），平均差值-12.0mm，95%CI-7.4 至-16.6，p<0.0001 I=0%。（3）在 2 项研究中，康复前后（n=29）进行恒定负荷运动试验时给予医用气流改善呼吸困难强度（改良 Borg 量表，0-10），平均差值-2.9，95%CI-3.2 至-2.7，p<0.0001 I=0%。
气流似乎可提供有意义的慢性呼吸困难缓解，应作为呼吸困难管理的辅助治疗。
