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Management of dyspnea in patients with chronic obstructive pulmonary disease

Behandlung der Atemnot bei Patienten mit chronisch obstruktiver Lungenerkrankung

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Zusammenfassung

Die chronisch obstruktive Lungenerkrankung (chronic obstructive pulmonary disease [COPD]) ist eine fortschreitende und schwächende Erkrankung, die weltweit zunehmend an Bedeutung gewinnt. Zusätzlich zur Basistherapie der Erkrankung erlangen palliativmedizinische Interventionen zur Symptomkontrolle besonders in fortgeschrittenen Stadien eine große Bedeutung. Nach Ausschöpfung der Basistherapie ist bei Patienten in fortgeschrittenen Stadien der COPD Symptomkontrolle als primäres Ziel einer erfolgreichen Behandlung anzusehen. Dyspnoe ist das am meisten belastende Symptom von COPD-Patienten. Wenn die Dyspnoe nicht mehr durch Ausschöpfung der Basistherapie bzw. Akuttherapie erleichtert werden kann (z. B. bei refraktärer Dyspnoe), verlagert sich das Ziel der Behandlung. Im Mittelpunkt stehen nun nicht mehr die Lebensverlängerung, sondern optimale Symptomkontrolle, verbesserte Funktionen und gesteigerte Lebensqualität. Um dieses Ziel zu erreichen, stehen zahlreiche pharmakologische und nicht-pharmakologische Interventionsmöglichkeiten zur Verfügung, deren Evidenz jedoch unterschiedlich bewertet wird. Dieser Review stellt einen Überblick von Behandlungsmöglichkeiten der refraktären Dyspnoe von COPD-Patienten im Bezug auf vorhandene Daten dar und beleuchtet Gebiete, die weiteren Untersuchungen bedürfen. Behandelte Themen sind Sauerstoff, Opioide, Psychotropika, inhalatives Furosemid, Heliox28, Ernährung, psychische Unterstützung und Atemtechniken.

Summary

A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. When dyspnea cannot be relieved by traditional COPD management strategies (i.e., "refractory dyspnea"), the goal of care shifts from prolonged survival to minimized symptoms, improved function, and enhanced quality of life. Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques.

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, Duke University Medical Center (DUMC), Durham, North Carolina, USA

    Amy P. Abernethy, Hope E. Uronis & Jane L. Wheeler

  2. Division of Medicine, Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia

    David C. Currow

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  1. Amy P. Abernethy
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  2. Hope E. Uronis
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  3. Jane L. Wheeler
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  4. David C. Currow
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Correspondence to Amy P. Abernethy.

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Abernethy, A., Uronis, H., Wheeler, J. et al. Management of dyspnea in patients with chronic obstructive pulmonary disease. Wien Med Wochenschr 159, 583–590 (2009). https://doi.org/10.1007/s10354-009-0727-z

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