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Therapie von Atemnot, Angst und Depression bei fortgeschrittenen Lungenerkrankungen

Therapy of dyspnea, anxiety and depression in patients with advanced lung diseases

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Hintergrund

Atemnot, Angst und Depression sind häufige Symptome bei Patienten mit fortgeschrittenen Lungenerkrankungen und tragen wesentlich zur Einschränkung der Lebensqualität dieser Patienten bei.

Ziel der Arbeit

Zusammenfassung von nichtmedikamentösen und medikamentösen Behandlungsoptionen für Atemnot, Angst und Depression auf der Basis der vorhandenen Evidenz.

Material und Methoden

Auswertung von Primärstudien, Übersichtsarbeiten und Leitlinien zu den genannten Symptomen und deren Behandlung.

Ergebnisse

Wichtig für die Behandlung von Atemnot, Angst und Depression sind zunächst das Erkennen und die Evaluation. Zur Behandlung der Atemnot stehen nichtmedikamentöse Maßnahmen zur Verfügung wie allgemeine Informationen, ein Plan zum Umgang mit Atemnot, der Einsatz eines Handventilators, körperliche Aktivität und Rollatoren. Opioide sind Medikamente der ersten Wahl für eine therapierefraktäre Atemnot. Leicht- bis mittelgradige Depressionen sollten primär mittels Psychotherapie behandelt werden. Bei mittelgradigen und schweren Depressionen sollten zusätzlich Antidepressiva ergänzt werden. Für die medikamentöse Therapie der Angst gibt es keine ausreichende Evidenz.

Schlussfolgerung

Atemnot, Angst und Depression beeinträchtigen die Lebensqualität von Patienten mit fortgeschrittenen Lungenerkrankungen erheblich. Es gibt aber eine Reihe von Therapieoptionen, die zur Linderung der Symptome eingesetzt werden können.

Abstract

Background

Dyspnea, anxiety and depression are common symptoms in patients with advanced lung disease and markedly impair the quality of life of these patients.

Objective

Summary of non-pharmacological and pharmacological measures for dyspnea, anxiety and depression based on the available evidence.

Material and methods

Analysis of primary studies, reviews and guidelines for the named symptoms and their management.

Results

Recognition and assessment are initially essential for the management of dyspnea, anxiety and depression. Various non-pharmacological measures, such as general information, a management plan for coping with dyspnea, use of a handheld fan, physical activity and rollators are available for the management of dyspnea. Opioids are the drugs of choice for intractable dyspnea. Slight to moderate depression should be primarily treated by psychotherapy. Antidepressants are additionally indicated for moderate to severe depression. There is insufficient evidence for the pharmacological treatment of anxiety.

Conclusion

Dyspnea, anxiety and depression have a marked impact on the quality of life of patients with advanced lung disease. There are a number of treatment options which can be used to help relieve symptoms.

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Authors and Affiliations

  1. Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

    C. Bausewein

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Correspondence to C. Bausewein.

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Interessenkonflikt

C. Bausewein erhält eine Unterstützung durch das BMBF zur Testung der Effektivität einer Atemnotambulanz (Förderkennzeichen 01GY1331), zur Erstellung eines Cochrane-Reviews (Förderkennzeichen 01KG1502) und erhält ein Vortragshonorar von Bayer Healthcare.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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K. Kenn, Schönau/a. Königsee

M. Pfeifer, Donaustauf

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Bausewein, C. Therapie von Atemnot, Angst und Depression bei fortgeschrittenen Lungenerkrankungen. Pneumologe 13, 166–173 (2016). https://doi.org/10.1007/s10405-016-0033-6

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