Abstract：
To provide an evidence-based review on the use of corticosteroids for dyspnea in cancer patients.
Corticosteroids are commonly used for palliation of dyspnea; however, there is wide variation in how they are prescribed due to the paucity of high-quality evidence. Some clinicians would offer corticosteroids routinely regardless of the causes of dyspnea, while others would only prescribe corticosteroids selectively for specific indications, such as lymphangitic carcinomatosis, upper airway obstruction, superior vena cava obstruction, and cancer treatment-induced pneumonitis. Few mechanistic studies have been conducted to support the use of corticosteroids in cancer patients. Two double-blind, placebo-controlled randomized trials have examined the routine use of high-dose dexamethasone for dyspnea in cancer patients. A pilot study suggested some benefits, but the larger confirmatory trial revealed no improvement compared to the placebo and significantly more adverse events. The selective use of corticosteroids use is only based on observational studies such as case series.
The unfavorable risk:benefit ratio of high-dose dexamethasone suggests that it should not be routinely prescribed for dyspnea in cancer patients. More research is needed to assess the selective use of corticosteroids and identify patients most likely be benefit from corticosteroid use.
Corticosteroids are commonly used for palliation of dyspnea; however, there is wide variation in how they are prescribed due to the paucity of high-quality evidence. Some clinicians would offer corticosteroids routinely regardless of the causes of dyspnea, while others would only prescribe corticosteroids selectively for specific indications, such as lymphangitic carcinomatosis, upper airway obstruction, superior vena cava obstruction, and cancer treatment-induced pneumonitis. Few mechanistic studies have been conducted to support the use of corticosteroids in cancer patients. Two double-blind, placebo-controlled randomized trials have examined the routine use of high-dose dexamethasone for dyspnea in cancer patients. A pilot study suggested some benefits, but the larger confirmatory trial revealed no improvement compared to the placebo and significantly more adverse events. The selective use of corticosteroids use is only based on observational studies such as case series.
The unfavorable risk:benefit ratio of high-dose dexamethasone suggests that it should not be routinely prescribed for dyspnea in cancer patients. More research is needed to assess the selective use of corticosteroids and identify patients most likely be benefit from corticosteroid use.
摘要：
目的：对使用糖皮质激素治疗癌症患者呼吸困难进行循证综述。
结果：皮质类固醇通常用于缓解呼吸困难；然而，由于缺乏高质量的证据，它们的处方方式差异很大。一些临床医生会常规提供皮质类固醇，无论呼吸困难的原因如何，而其他人只会针对特定适应症选择性地开皮质类固醇处方，如淋巴管癌病，上气道阻塞,上腔静脉阻塞,和癌症治疗引起的肺炎。很少有机制研究支持在癌症患者中使用皮质类固醇。两个双盲，安慰剂对照随机对照试验研究了癌症患者常规使用大剂量地塞米松治疗呼吸困难的情况.一项试点研究提出了一些好处，但更大的验证性试验显示,与安慰剂相比没有改善,且不良事件明显更多.皮质类固醇的选择性使用仅基于观察性研究，例如病例系列。
结论：大剂量地塞米松的不利风险：获益比表明，对于癌症患者的呼吸困难，不应常规使用大剂量地塞米松。需要更多的研究来评估皮质类固醇的选择性使用，并确定患者最有可能从皮质类固醇使用中受益。
结果：皮质类固醇通常用于缓解呼吸困难；然而，由于缺乏高质量的证据，它们的处方方式差异很大。一些临床医生会常规提供皮质类固醇，无论呼吸困难的原因如何，而其他人只会针对特定适应症选择性地开皮质类固醇处方，如淋巴管癌病，上气道阻塞,上腔静脉阻塞,和癌症治疗引起的肺炎。很少有机制研究支持在癌症患者中使用皮质类固醇。两个双盲，安慰剂对照随机对照试验研究了癌症患者常规使用大剂量地塞米松治疗呼吸困难的情况.一项试点研究提出了一些好处，但更大的验证性试验显示,与安慰剂相比没有改善,且不良事件明显更多.皮质类固醇的选择性使用仅基于观察性研究，例如病例系列。
结论：大剂量地塞米松的不利风险：获益比表明，对于癌症患者的呼吸困难，不应常规使用大剂量地塞米松。需要更多的研究来评估皮质类固醇的选择性使用，并确定患者最有可能从皮质类固醇使用中受益。
