Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Research and Development, Ciro, Horn.
Curr Opin Support Palliat Care. 2023 Dec 1;17(4):263-269. doi: 10.1097/SPC.0000000000000674. Epub 2023 Oct 26.
The net clinical benefit of opioids for chronic breathlessness has been challenged by recent randomized clinical trials. The purpose was to review and weigh the evidence for and against opioid treatment for chronic breathlessness in people with serious disease.
Evidence to date on the efficacy and safety of opioids for chronic breathlessness was reviewed. Findings supporting a benefit from opioids in meta-analyses of earlier, mostly smaller trials were not confirmed by recent larger trials. Evidence pertains mostly to people with chronic obstructive pulmonary disease but also to people with pulmonary fibrosis, heart failure, and advanced cancer. Taken together, there is no consistent evidence to generally recommend opioids for severe breathlessness or to identify people who are more likely to benefit. Opioid treatment may be tested in patients with intractable breathlessness and limited other treatment options, such as in end-of-life care. Knowledge gaps were identified and recommendations were made for future research.
Key Points: Supportive findings of net benefit of opioids for chronic breathlessness in earlier trials have not been confirmed by recent larger randomized clinical trials. There is no evidence that the opioid treatment improves the person’s exercise capacity or quality of life, and it increases the risk of adverse events. Evidence to date does not support that opioids should generally be recommended for treating breathlessness. In people with intractable symptoms and short expected survival, with few or no treatment options, it may still be reasonable to try opioid treatment with the aim to alleviate severe breathlessness. Research is needed to explore the potential benefit of opioids in selected patient groups. Opioids cannot be generally recommended for treating breathlessness based on insufficient evidence for net clinical benefit.
最近的随机临床试验对阿片类药物治疗慢性呼吸困难的净临床获益提出了质疑。本综述旨在回顾和权衡在严重疾病患者中使用阿片类药物治疗慢性呼吸困难的利弊证据。
对阿片类药物治疗慢性呼吸困难的疗效和安全性的现有证据进行了回顾。早期、大多数较小的试验的荟萃分析支持阿片类药物有效，但最近较大的试验并未证实这一发现。证据主要涉及慢性阻塞性肺疾病患者，但也涉及肺纤维化、心力衰竭和晚期癌症患者。总的来说，没有一致的证据普遍推荐阿片类药物治疗严重呼吸困难，也无法确定哪些人更可能从中受益。阿片类药物治疗可能在难治性呼吸困难且其他治疗选择有限的患者中进行测试，例如在临终关怀中。本研究确定了知识空白，并为未来的研究提出了建议。
要点：早期试验中支持阿片类药物治疗慢性呼吸困难的净获益的发现，并未被最近较大的随机临床试验所证实。没有证据表明阿片类药物治疗能改善患者的运动能力或生活质量，反而会增加不良反应的风险。迄今为止的证据不支持普遍推荐阿片类药物治疗呼吸困难。对于症状严重且预期生存时间短、治疗选择有限或几乎没有的患者，尝试用阿片类药物治疗以缓解严重呼吸困难可能仍然是合理的。需要研究探索阿片类药物在特定患者群体中的潜在获益。由于缺乏阿片类药物治疗慢性呼吸困难的净临床获益的充分证据，不能普遍推荐阿片类药物治疗呼吸困难。
