Background

Exertional dyspnea in interstitial lung disease (ILD) remains difficult to manage despite advances in disease-targeted therapies. Pulmonary opioid receptors present a potential therapeutic target for nebulized fentanyl to provide dyspnea relief.

Methods

ILD patients were characterized with reference to healthy volunteers. A randomized, double-blind, placebo-controlled crossover comparison of 100 mcg nebulized fentanyl vs placebo on dyspnea intensity and inspiratory neural drive (IND) during constant work rate (CWR) cycle exercise was performed in 21 ILD patients.

Results

Dyspnea intensity in ILD increased in association with an increase in IND (diaphragm activation) from a high resting value of 16.66 ± 6.52 %–60.04 ± 12.52 % of maximum (r = 0.798, p < 0.001). At isotime during CWR exercise, Borg dyspnea intensity ratings with fentanyl vs placebo were 4.1 ± 1.2 vs 3.8 ± 1.2, respectively (p = 0.174), and IND responses were also similar.

Conclusion

IND rose sharply during constant work rate exercise in association with dyspnea intensity in mild to moderate ILD but was not different after nebulized fentanyl compared with placebo.

中文翻译：

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间质性肺病中的吸气神经驱动和呼吸困难：吸入芬太尼的影响。

背景

尽管针对疾病的治疗取得了进展，但间质性肺病 (ILD) 中的劳力性呼吸困难仍然难以控制。肺阿片受体是雾化芬太尼缓解呼吸困难的潜在治疗靶点。

方法

ILD 患者的特征参考健康志愿者。在 21 名 ILD 患者中进行了一项随机、双盲、安慰剂对照的交叉比较，比较了 100 mcg 雾化芬太尼与安慰剂对恒定工作速率 (CWR) 循环运动期间呼吸困难强度和吸气神经驱动 (IND) 的影响。

结果

ILD 的呼吸困难强度随着 IND（膈肌激活）的增加而增加，从高静息值 16.66 ± 6.52 %–60.04 ± 12.52 % 最大值（r = 0.798，p < 0.001）。在 CWR 运动期间，芬太尼与安慰剂的 Borg 呼吸困难强度等级分别为 4.1 ± 1.2 和 3.8 ± 1.2 (p = 0.174)，并且 IND 反应也相似。

结论

在轻度至中度 ILD 中，与呼吸困难强度相关的恒定工作速率运动期间 IND 急剧上升，但与安慰剂相比，雾化芬太尼后没有差异。