Department of Respiratory Medicine, The Alfred Hospital, Prahan, Australia
RespiratoryResearch@Alfred, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia.
Eur Respir Rev. 2024 Oct 9;33(174). doi: 10.1183/16000617.0265-2023. Print 2024 Oct.
People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear.
We examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1.
Out of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was "very low" to "low". Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) -0.37, 95% CI -0.67- -0.07), but not breathlessness measured in daily life (SMD -0.10, 95% CI -0.64-0.44). No effects on HRQoL (SMD -0.42, 95% CI -0.98-0.13) or cough (SMD -1.42, 95% CI -3.99-1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70-6.51), constipation (OR 3.08, 95% CI 1.69-5.61) and drowsiness (OR 1.37, 95% CI 1.01-1.86), with serious adverse events including hospitalisation and death identified.
Opioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits.
患有严重呼吸系统疾病的人会经历严重的痛苦症状。尽管阿片类药物被用于缓解症状，但它们会产生不良反应，且其疗效并不明确。
我们研究了阿片类药物治疗严重呼吸系统疾病患者的症状管理效果和安全性。我们检索了 Embase、MEDLINE 和 Cochrane 对照试验中心注册库，检索时间截至 2022 年 7 月 11 日。纳入了报告随机对照试验结果的研究，这些研究向患有严重呼吸系统疾病的患者施用阿片类药物以治疗症状。主要排除标准为：参与者中<80%患有非恶性肺部疾病。我们提取了研究特征、呼吸困难、咳嗽、健康相关生活质量（HRQoL）和不良反应结局的数据。使用具有随机效应的通用倒数方差模型汇总治疗效果。使用 Cochrane 偏倚风险工具（版本 1）评估偏倚风险。
在纳入的 17 项试验中，有 6 项是实验室基础运动试验（n=70），10 项是家庭研究，用于测量日常生活中的呼吸困难（n=788），1 项（n=18）同时在这两种环境下进行。证据总体确定性为“非常低”到“低”。阿片类药物降低了实验室运动测试中的呼吸困难强度（标准化均数差（SMD）-0.37，95%置信区间（CI）-0.67-0.07），但对日常生活中的呼吸困难没有影响（SMD-0.10，95%CI-0.64-0.44）。未检测到对 HRQoL（SMD-0.42，95%CI-0.98-0.13）或咳嗽（SMD-1.42，95%CI-3.99-1.16）的影响。在家庭研究中，阿片类药物导致恶心/呕吐的频率增加（OR 3.32，95%CI 1.70-6.51）、便秘（OR 3.08，95%CI 1.69-5.61）和嗜睡（OR 1.37，95%CI 1.01-1.86），严重不良事件包括住院和死亡。
阿片类药物改善了实验室运动研究中的运动性呼吸困难，但没有改善家庭日常生活中的呼吸困难、咳嗽或 HRQoL。存在严重的不良反应，这可能超过任何益处。
