title: [Pharmacological therapy of refractory dyspnoea : a systematic literature review].
abstract: BACKGROUND
  The management of breathlessness in patients with life-limiting diseases is still difficult and complex. This systematic review aims to summarize and analyze clinical trials of four different treatment options (opioids, benzodiazepines, corticosteroids and oxygen) for the relief of breathlessness.
  
  
  METHODS
  A systematic review based on database searching of Medline, Embase and Cochrane Library was carried out and experts in the field were contacted. The search was conducted in July 2011. Included were systematic reviews, controlled and randomized controlled clinical trials in patients suffering from breathlessness due to advanced disease. Studies were selected, extracted and the data analyzed by two independent reviewers using narrative synthesis.
  
  
  RESULTS
  The search retrieved 2,559 hits. Five systematic reviews and 10 randomized controlled trials were included. Opioids (oral and parenteral) were the only drug group with evidence for relief of breathlessness. Benzodiazepines failed to show a significant effect for the relief of breathlessness intensity but demonstrated a tendency towards benefit. No studies were identified assessing steroids. There is no additional benefit from oxygen compared to room air in non-hypoxemic cancer patients but there is a statistically significant benefit of oxygen in non-hypoxemic COPD patients.
  
  
  CONCLUSIONS
  Oral and parenteral opioids seem to be effective for the relief of breathlessness and should be the first choice for pharmacological treatment. Benzodiazepines should be used with reservation. There is not enough evidence for the use of steroids except for COPD patients. Non-hypoxemic cancer patients do not benefit from oxygen. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
authors.affiliation: Zentrum für Palliativmedizin, Klinisches Studienzentrum Palliativmedizin (BMBF 01KN1106), Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland. steffen@steffensimon.de
authors.forename: S T
authors.initials: ST
authors.lastname: Simon
authors.forename: P
authors.initials: P
authors.lastname: Köskeroglu
authors.forename: C
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D001569:Benzodiazepines