COPD benzodiazepine warning

Canadian researchers have found that benzodiazepines are frequently prescribed for patients with chronic obstructive pulmonary disease (COPD), despite their known association with adverse respiratory outcomes.

International guidelines say the hypnotics should be avoided in patients with severe COPD but, concerningly, the findings showed that the worse a patient's disease, the more likely they were to be prescribed the drugs.

"Individuals with more severe COPD are more respiratory-vulnerable than those with lesser degrees of COPD, and might therefore be more susceptible to potential respiratory-related benzodiazepine complications," say Nicholas Vozoris (University of Toronto, Ontario) and colleagues.

The study, reported in Drugs and Aging, included 111,445 patients aged 66 years or older with COPD in the Ontario region. Over the 5-year study period, 35,311 (31.7%) patients were newly prescribed a benzodiazepine.

Patients with more severe COPD (at least one emergency or hospital admission within previous year) had 43% greater odds for receiving a new prescription than those with less severe COPD (no admission within previous year; 42.2 vs 29.4%).

An additional concern was that 9% of new benzodiazepine prescriptions were made during or shortly after hospital admission for exacerbation, even though this is not a recognized treatment in respiratory guidelines. However, the overall majority (79.5%) of new prescriptions came from family doctors.

The authors also found patterns of suboptimal benzodiazepine use in the study including prescription of long-acting agents (14.6%), prescriptions for longer than 30 days (32.6%), repeat prescriptions (up to 30.6%), and early refills (11.6%).

Benzodiazepine use in COPD patients has been associated with several poor respiratory outcomes, including decreased minute ventilation, hypoxemia, hypercapnea, and decreased respiratory muscle strength and endurance, explain the authors.

The drugs are indicated for insomnia, depression, and anxiety, all of which are common among COPD patients. Additionally, they are sometimes prescribed to reduce the sensation of dyspnea, although evidence to support this use is lacking.

Vozoris and colleagues conclude that, now the high prevalence of their use has been established, future studies will be needed to examine the health outcomes among COPD patients taking benzodiazepines.

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