Pulmonary Department, Nancy, France.
InsermU955, team 04, 8 rue du general Sarrail, 94000, Créteil, France.
BMC Pulm Med. 2019 May 16;19(1):95. doi: 10.1186/s12890-019-0851-5.
Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort.
A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management.
Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness.
Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.
呼吸困难是慢性阻塞性肺疾病（COPD）的突出症状。尽管进行了包括药物和非药物干预在内的最佳治疗管理，但许多 COPD 患者仍存在明显的呼吸困难。慢性呼吸困难定义为在对基础疾病进行最佳治疗后仍持续存在的呼吸困难。由于与慢性呼吸困难相关的主要残疾，包括阿片类药物在内的对症治疗已被多位作者推荐。COPD 患者慢性呼吸困难的患病率及其在常规临床实践中的管理情况调查不足。我们的目的是检查在法国一家三级医院的真实队列中招募的 COPD 患者中慢性呼吸困难的患病率、相关特征和管理情况。
对 120 例稳定期 COPD 患者进行前瞻性研究，这些患者在法国南锡大学医院招募。与此同时，要求同一地理区域的 88 名肺病学家回答关于呼吸困难管理的在线问卷。
64 名（53%）患者尽管有 94%的患者接受了最佳吸入药物治疗，但仍有严重的呼吸困难（改良医学研究理事会量表≥3）；40%的患者在过去 2 年内接受过肺康复治疗。呼吸困难的严重程度随着气流受限的增加而增加。呼吸困难与焦虑、抑郁症状加重以及骨质疏松症有关。与其他症状、加重率或心血管合并症无关。在有慢性呼吸困难和住院焦虑和/或抑郁评分>10 的患者中，只有 25%接受了抗抑郁药或抗焦虑药治疗。在接受调查的肺病学家中，有 46 名（52%）回答了问卷，表示非常愿意为慢性呼吸困难开具阿片类药物，但实际上这些患者都没有接受过这种治疗。
COPD 患者对呼吸困难及其相关心理困扰的治疗方法不足。本研究强调了对肺康复和呼吸困难对症治疗的使用不足。
