严重且难治性的慢性呼吸困难是晚期生命限制性疾病患者的常见且繁重的症状。由于缺乏有效的干预措施，其临床管理具有挑战性。为安全使用药物治疗严重慢性呼吸困难提供实践建议。（国际）国家指南和系统评价的范围审查。我们还检索了无法确定系统评价的初步研究。国际专家小组对这些建议达成了 75% 的共识。MEDLINE、Cochrane 图书馆和指南国际网络的搜索截止日期为 2023 年 3 月。纳入关于使用抗抑郁药、苯二氮卓类药物、阿片类药物或皮质类固醇治疗成人慢性呼吸困难的出版物癌症、慢性阻塞性肺疾病、间质性肺疾病或慢性心力衰竭。总体而言，来自 8 项指南、14 项系统评价和 3 项抗抑郁药随机对照试验 (RCT) 的证据有限。对于患有慢性阻塞性肺病、癌症和间质性肺病的患者，有低质量的证据支持阿片类药物。对于慢性心力衰竭，证据尚无定论。仅应考虑使用苯二氮卓类药物来治疗与严重呼吸困难相关的焦虑。不应使用抗抑郁药和皮质类固醇。呼吸困难的治疗仍然具有挑战性，只有少数药物选择，且证据有限且部分相互矛盾。因此，对于晚期疾病患者，在优化基础病情并使用循证非药物干预作为一线治疗后，应在副作用监测下保留药物治疗。

Severe and refractory chronic breathlessness is a common and burdensome symptom in patients with advanced life-limiting disease. Its clinical management is challenging because of the lack of effective interventions.To provide practice recommendations on the safe use of pharmacological therapies for severe chronic breathlessness.Scoping review of (inter)national guidelines and systematic reviews. We additionally searched for primary studies where no systematic review could be identified. Consensus on the recommendations was reached by 75% approval within an international expert panel.Searches in MEDLINE, Cochrane Library and Guideline International Network until March 2023. Inclusion of publications on the use of antidepressants, benzodiazepines, opioids or corticosteroids for chronic breathlessness in adults with cancer, chronic obstructive pulmonary disease, interstitial lung disease or chronic heart failure.Overall, the evidence from eight guidelines, 14 systematic reviews and 3 randomised controlled trials (RCTs) on antidepressants is limited. There is low quality evidence favouring opioids in patients with chronic obstructive pulmonary disease, cancer and interstitial lung disease. For chronic heart failure, evidence is inconclusive. Benzodiazepines should only be considered for anxiety associated with severe breathlessness. Antidepressants and corticosteroids should not be used.Management of breathlessness remains challenging with only few pharmacological options with limited and partially conflicting evidence. Therefore, pharmacological treatment should be reserved for patients with advanced disease under monitoring of side effects, after optimisation of the underlying condition and use of evidence-based non-pharmacological interventions as first-line treatment.