Department of Pulmonary Medicine, Fujieda Municipal General Hospital, 4-1-11 Surugadai, 426-8677, Fujieda, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, 431-3192, Hamamatsu, Japan.
Respir Res. 2022 Oct 29;23(1):294. doi: 10.1186/s12931-022-02204-5.
Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). AE-IPF patients require optimal palliative care; however, the real-world clinical situations are poorly understood. We aimed to survey the palliative care received by AE-IPF patients, especially with respect to opioid use for dyspnea and the end-of-life discussions (EOLd).
Self-administered questionnaires were dispatched to 3423 of the certified pulmonary physicians in Japan. They were asked to report a care report form of one patient each with AE-IPF who died very recently about opioid use for dyspnea and EOLd. We further explored the factors associated with the early use of opioids for dyspnea.
Among the 3423 physicians, 1226 (35.8%) returned the questionnaire with the report forms of 539 AE-IPF patients. Of 539 AE-IPF patients, 361 (67.0%) received opioids for dyspnea. Of the 361 patients, 72 (20.0%) received opioids during the initial treatment with an intention of recovery (early use), while 289 (80.0%) did when the recovery was deemed impossible. EOLd was held before the onset of AE in 124 patients (23.0%); however, the majority of patients had EOLd after the admission for AE-IPF. EOLd before the onset of AE was significantly associated with the early use of opioids.
In terminally ill AE-IPF patients, opioids are usually administered when the recovery is deemed impossible, and EOLd are rarely held before the onset of AE. Further studies are warranted on the efficacy of opioids for dyspnea and the appropriate timing of EOLd.
急性加重（AE）是特发性肺纤维化（IPF）患者死亡的主要原因。AE-IPF 患者需要最佳的姑息治疗；然而，现实世界的临床情况了解甚少。我们旨在调查 AE-IPF 患者接受的姑息治疗情况，特别是关于呼吸困难的阿片类药物使用和临终讨论（EOLd）。
向日本的 3423 名认证肺病医生发放了自我管理问卷。他们被要求报告一位最近死于 AE-IPF 的患者的护理报告表，内容涉及呼吸困难和 EOLd 中阿片类药物的使用情况。我们进一步探讨了与呼吸困难早期使用阿片类药物相关的因素。
在 3423 名医生中，有 1226 名（35.8%）返回了问卷，并附有 539 名 AE-IPF 患者的报告表。在 539 名 AE-IPF 患者中，有 361 名（67.0%）因呼吸困难接受了阿片类药物治疗。在这 361 名患者中，有 72 名（20.0%）在意图恢复的初始治疗中接受了阿片类药物治疗（早期使用），而 289 名（80.0%）在恢复被认为不可能时接受了治疗。在 124 名患者（23.0%）中，在 AE 发作前进行了 EOLd；然而，大多数患者在因 AE-IPF 入院后才进行 EOLd。AE 发作前进行 EOLd 与早期使用阿片类药物显著相关。
在终末期 AE-IPF 患者中，阿片类药物通常在恢复被认为不可能时使用，并且在 AE 发作前很少进行 EOLd。需要进一步研究阿片类药物治疗呼吸困难的疗效和 EOLd 的适当时机。
