Zusammenfassung
Patienten mit nichtonkologischen Erkrankungen zeichnen sich im fortgeschrittenen und lebenslimitierenden Erkrankungsstadium durch eine hohe Symptomlast aus. Palliativmedizinische Behandlungskonzepte werden bei diesen Patienten in Deutschland noch zu wenig und oft zu spät eingesetzt. Die unterschiedlichen Symptome (Dyspnoe, Husten, Kachexie, Fatigue, Angst und Depression) und deren medikamentöse und nichtmedikamentöse Kontrolle werden dargestellt. Die Herausforderung bei der Betreuung von Patienten mit chronisch obstruktiver Atemwegserkrankung (COPD) liegt darin, den palliativmedizinischen Bedarf zu erkennen und interdisziplinär umzusetzen.
Abstract
Patients with advanced stage, non-oncological incurable and life-threatening diseases, such as chronic obstructive pulmonary disease (COPD), are characterized by the presence of many symptoms. Palliative care concepts for these patients are not yet available throughout Germany and are often implemented too late. The different symptoms, such as dyspnea, coughing, cachexia, fatigue, fear and depression as well as the pharmaceutical and non-pharmaceutical management are presented. The challenge for the care of patients with advanced stage COPD is to recognize the palliative care requirements and to implement the appropriate measures in an interdisciplinary manner.
Literatur
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blindermann CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-lung cancer. N Engl J Med 363:733–742
Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE (2012): An official American Thoracic Society Statement: update on the mechanism, assessment and management of dyspnea. Am J Respir Crit Care Med 185(4):435–452
Gupta R, Goldstein R, Brooks D (2006) The acute effects of a rollator in individuals in COPD. J Cardiopulmrehabil 26:107–111
Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ (2002) Home based neuromuscular electrical Stimulation as a new rehabilitative strategy for serverely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax 57:333–337
Galbraith S, Fagan P, Perkins P, Lynch A, Booth S (2010) Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manag 39:831–838
Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE (2002) A systematic review of the use of opiods in the management of dyspnoea. Thorax 57:939–949
Abernethy AP, Currow DC, Frith P et al (2003) Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 327:523–528
Simon ST, Higginsons IJ, Booth S et al (2010) Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev, Issue 1. Art. No.:CD007354
Abernethy AP, Mc Donald CF, Frith PA et al (2010) Effect of palliative oxygen verus room air in relief of breathlessness in patients with refractory dyspnoea: a doubl-blind, randomized controlled trial. Lancet 376:784–793
Currow DC, Agar M, Smith J, Abernethy AP (2009) Does palliative home oxygen improve dyspnoea? A consecutive cohort study. Palliat Med 23:309–316
Wee B, Browning J, Adams A et al (2012) Management of chronic cough in patients receiving palliative care: review of evidence and recommendations by a task group of the Association for Palliative Medicine of Great Britain and Ireland. Palliat Med 26:780–787
Kardos P, Berck H, Fuchs KH, Gillissen A, Klimek L, Morr H, Pfeiffer Kascha D, Schulze Werninghaus G, Sitter H, Voshaar T, Worth H (2010) Guidelines of the German Respiratory Society for diagnosis und treatment of adults suffering from acute or chronic cough. Pneumologie 64:701–711
Matthys H, Bleicher B, Bleicher U (1983) Dextromethorphan and codeine: objective assessment of antitussive activity in patients with chronic cough. J Int Med Res 11:92–100
Sanders RV, Kirkpatrick MB (1984) Prolongend suppression of cough after inhalation of lidocaine in a patient with sarcoid. JAMA 252:2456–2457
Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG (1996) Nutrional status and martality in chronic obstructive pulmonary disease. Am J Respircrit Care Med 153:961–966
Paddison JS, Effing TW, Quinn S, Frith PA (2013) Fatigue in COPD association with functional status and hospitalisations. Eur Respir J 41(3):565–570
Temel J, Currow D, Fearon K, Gleich L, Yan Y, Friend J, Abernethy A (2014) 1483O_PR – Anamorelin for the treatment of cancer anorexia-cachexia in NSCLC: Results from the phase 3 studies ROMANA 1 and 2. Ann Oncol 25(5):1–41
Miki K, Maekura R, Nagaya N, Kakazato M, Kimura H et al (2012) Grhelin treatment of cachectic patients with chronic obstructive pulmonary disease: a multicenter, randomized, double-blind, placebo-controlled trial. PLos ONE 7:e35708
Budweiser S, Heinemann F, Meyer K, Wild PJ, Pfeifer M (2006) Weight gain in cachectic COPD patients receiving noninvasive positive-pressure ventilation. Respir Care 51:126–132
Yennuarajalignam S, Palmer JL, Chacko R, Bruera E (2011) Factors associated with response to methylphenidate in advanced cancer patients. Oncologist 16:246–253
Hynninen KM, Breitve MH, Wiborg AB, Pallesen S, NordhusI H (2005) Psychological charateristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res 59:429–443
Argyropoulou P, Patakas D, Koukou A, Vasiliadis P, Georgopoulos D (1993) Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration 60:216–220
Singh NP, Despars JA, Stansbury DW, Avalos K, Light RW (1993) Effects of buspirone on anxiety levels and exercise tolerance in patients with chronic airflow obstruction and mild anxiety. Chest 103:800–804
Borson S, McDonald GJ, Gayle T, Deffebach M, Lakshminaravan S, VanTuinen C (1992) Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychomatics 33:190–201
Emery CF, Schein RL, Hauck ER, MacIntyre NR (1998) Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol 17:232–240
Van Ede L, Yzermans CJ, Brouwer HJ. (1999) Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax 54:688–692
Lacasse Y, Rousseau L, Maltais F (2001) Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease. J Cardiopulmrehabil 21:80–86
Hill K, Geist R, Goldstein RS, Lacasse Y (2008) Anxiety and depression in end-stage COPD. Eur Respir J 31:667–677
Gore JM, Brophy CJ, Greenstone MA (2000) How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax 55:1000–1006
Varkey B (2006) Unfulfilled palliative care needs of chronic pumonary disease patients. Curropinpulm Med 12:103–105
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Barchfeld, T. Palliativmedizin bei nichtmalignen chronisch pulmonalen Erkrankungen. Pneumologe 13, 96–103 (2016). https://doi.org/10.1007/s10405-015-0016-z
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DOI: https://doi.org/10.1007/s10405-015-0016-z