Control de los síntomas en pacientes terminales: efectividad del tratamiento de la disnea irruptiva con opioides

摘要

Introduction and objective: Breakthrough dyspnea (BD) is frequently suffered by in terminally ill patients. The main objecti- ve of the study was to assess the degree of symptom control for patients admitted to our unit specially the effectiveness of BD therapy in terminally ill patients. Patients and methods: An observational study of a registry of patients was completed and performed at a Spanish hospice care unit. Terminally ill patients presenting with BD and having undergone opioid treatment were selected. BD’s intensity was measured prior to and after treatment using the Borg scale. The intensity of other symptoms was evaluated using the Edmonton Symptom Assessment System (ESAS) scale. Results: One hundred patients were included in the analysis. Males comprised 65 % of the sample, being 55 % oncological patients. Sublingual fentanyl (71 %), intranasal fentanyl (18 %), oral fentanyl (1 %) and subcutaneous morphine (10 %) were administered. Treatment response was observed in 94 % of pa- tients with improvements of two or more points on the Borg Scale for BD, with no differences between treatments. The sa- fety profile was acceptable in all cases. Conclusions: Although opioids are recommended in the first line of treatment of ID, there is not enough scientific evidence to justify its use. It was observed in the study that fentanyl may be an effective and safe therapeutic option for the control of breakthrough dyspnea in terminally ill patients.