Monash Lung and Sleep, 2538Monash Health, Clayton, Victoria, Australia.
Department of Palliative Care, 90134The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Am J Hosp Palliat Care. 2021 May;38(5):472-479. doi: 10.1177/1049909120959061. Epub 2020 Sep 17.
Patients with advanced chronic obstructive pulmonary disease (COPD) can develop increasing breathlessness, which can persist despite optimal medical management-refractory breathlessness. Management can be challenging for all clinicians and requires a broad approach that includes optimization of disease directed therapies, non-pharmacological strategies to manage breathlessness and for some patients opioids.
To explore the approaches to breathlessness management and palliative care undertaken by Australian General Practitioners (GP) for patients with severe COPD and refractory breathlessness.
A case-vignette based survey was conducted with Australian GPs to determine their approaches to breathlessness management and palliative care in COPD.
Of the 137 GPs, 66% recommended commencing an additional medication to manage refractory breathlessness. Thirty-eight GPs (28%) recommended opioids and 26 (19%) recommended guideline discordant treatments. Two-thirds of GPs had concerns regarding the use of opioids in COPD. Half (55%) of GPs were comfortable providing general palliative care to patients with COPD and 62 (45%) had referred patients with COPD to specialist palliative care services. Most respondents wanted further training to manage severe COPD and severe chronic breathlessness.
Most GPs recognized and were willing to add specific treatments for severe chronic breathlessness. However, experience prescribing opioids for severe chronic breathlessness was low, with many practitioners holding significant concerns regarding adverse effects. Many GPs are uncomfortable offering a palliative approach to their COPD patients, yet these patients are not routinely referred to specialist palliative care services despite their immense needs. GPs therefore desire education and support to overcome these barriers.
患有晚期慢性阻塞性肺疾病（COPD）的患者可能会出现呼吸急促加重的情况，即使接受了最佳的药物治疗，这种情况仍会持续存在，即难治性呼吸困难。所有临床医生都需要对这种情况进行治疗，这是一个具有挑战性的问题，需要采取广泛的方法，包括优化针对疾病的治疗方法、非药物策略来管理呼吸困难，以及对于一些患者使用阿片类药物。
探索澳大利亚全科医生（GP）针对严重 COPD 和难治性呼吸困难患者采取的呼吸困难管理和姑息治疗方法。
采用基于病例的调查方法对澳大利亚 GP 进行调查，以确定他们在 COPD 患者呼吸困难管理和姑息治疗方面的方法。
在 137 名 GP 中，66%的人建议开始使用额外的药物来治疗难治性呼吸困难。38 名 GP（28%）建议使用阿片类药物，26 名 GP（19%）建议使用与指南不符的治疗方法。三分之二的 GP 对 COPD 患者使用阿片类药物存在顾虑。一半（55%）的 GP 对为 COPD 患者提供一般姑息治疗感到舒适，62 名（45%）的 GP 将 COPD 患者转介到专门的姑息治疗服务机构。大多数受访者希望进一步接受治疗严重 COPD 和严重慢性呼吸困难的培训。
大多数 GP 认识到并愿意为严重慢性呼吸困难添加特定的治疗方法。然而，开处方治疗严重慢性呼吸困难的经验较少，许多从业者对不良反应存在重大担忧。许多 GP 对为他们的 COPD 患者提供姑息治疗方法感到不舒服，但这些患者尽管有巨大的需求，却没有被常规转介到专门的姑息治疗服务机构。因此，GP 希望接受教育和支持以克服这些障碍。
