慢性呼吸困难的阿片类药物和非阿片类药物治疗更新。
Updates in opioid and nonopioid treatment for chronic breathlessness.
机构信息
Department of Kinesiology and Physical Education, Clinical Exercise & Respiratory Physiology Laboratory.
McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University.
出版信息
Curr Opin Support Palliat Care. 2019 Sep;13(3):167-173. doi: 10.1097/SPC.0000000000000449.
PURPOSE OF REVIEW
Chronic breathlessness is a troublesome symptom experienced by people with advanced malignant and nonmalignant disease. Disease-directed therapies are often insufficient in the management of chronic breathlessness. Therefore, pharmacological and nonpharmacological breathlessness-specific interventions should be considered for select patients.
RECENT FINDINGS
There is some evidence to support the use of low-dose opioids (≤30 mg morphine equivalents per day) for the relief of breathlessness in the short term. However, additional studies are needed to understand the efficacy of opioids for chronic breathlessness in the long term.Nonopioid therapies, including inspiratory muscle training, fan-to-face therapy, L-menthol and inhaled nebulized furosemide show some promise for the relief of breathlessness in advanced disease. There is insufficient evidence to support the use of anxiolytics and benzodiazepines and cannabis for chronic breathlessness.
SUMMARY
More research is needed to identify therapies for the management of chronic breathlessness.
目的综述
慢性呼吸困难是晚期恶性和非恶性疾病患者的一种常见症状。针对疾病的治疗往往不足以缓解慢性呼吸困难。因此，对于特定患者，应考虑使用药理学和非药理学的专门针对呼吸困难的干预措施。
最近的发现
有一些证据支持在短期内使用低剂量阿片类药物（每天≤30 毫克吗啡等效物）来缓解呼吸困难。然而，还需要进一步的研究来了解阿片类药物在长期内对慢性呼吸困难的疗效。非阿片类药物治疗，包括吸气肌训练、对脸吹风治疗、L-薄荷醇和吸入性布美他尼雾化，在缓解晚期疾病中的呼吸困难方面显示出一定的前景。目前尚无足够的证据支持使用抗焦虑药、苯二氮䓬类药物和大麻来治疗慢性呼吸困难。
总结
需要更多的研究来确定治疗慢性呼吸困难的方法。
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