Vor allem in sehr fortgeschrittenen Krankheitsstadien der COPD mit „refraktärer Dyspnoe“ können neben einer Therapie der Grunderkrankung palliative Therapiemaßnahmen wie eine medikamentöse Therapie mit Opioiden zur Linderung der Dyspnoe erforderlich sein. Es gibt deutliche Hinweise darauf, dass diese wirksame Therapie bislang nur bei einem geringen Teil derjenigen COPD-Patienten eingesetzt wird, die davon profitieren könnten.
Abstract
Dyspnea is a leading symptom in COPD. Bronchodilators (long acting anticholinergics and long acting beta agonists) are the mainstay of medical treatment. Non pharmacological therapies like pulmonary rehabilitation, long-term oxygen therapy or lung volume reduction can help to further improve dyspnea. Nevertheless, patients with advanced disease may develop refractory dyspnea. Randomized controlled trials demonstrated that the palliative treatment with low-dose systemic opioids is an effective treatment option in these patients. A low starting dose (e. g. 1.0 mg morphine, immediate release) is recommended. Subsequent doses are titrated to achieve the lowest effective dose based on whether dyspnea relief has been achieved and whether any side effects have developed. This low-dose opioid treatment has been demonstrated to be safe for symptom reduction in severe COPD and is not associated with increased hospital admissions or deaths. Physicians should offer a trial of low-dose oral opioids to patients with refractory dyspnea that affects their daily activities and quality of life.
Schlüsselwörter COPD - Dyspnoe - Palliativtherapie - Opioide - Opiate
Keywords COPD - dyspnea - palliative care - opioids - medical therapy
