Opioid and benzodiazepine use was associated with more adverse respiratory events in older adults with chronic obstructive pulmonary disease (COPD), according to a study published in Annals of the American Thoracic Society.
Furthermore, although adverse effects are not exacerbated in individuals with obstructive sleep apnea, those with high-complexity COPD are at greater risk for adverse events when using both opioids and benzodiazepine.
This case-control study included 3232 individuals who were hospitalized in 2014 for COPD or a related diagnosis, as well as 6247 controls matched for age, gender, socioeconomic status, COPD medication and complexity, obstructive sleep apnea, comorbidity, and index date. All participants were taken from the 5% national Medicare database, were Medicare beneficiaries, and were ≥66 years old (mean age, 77 years). The risk for respiratory hospitalization was calculated using conditional logistic regression models.
Compared with patients who did not use opioids or benzodiazepine, the risk for respiratory hospitalization was significantly greater in patients who used opioids alone (adjusted odds ratio [aOR], 1.73; 95% CI, 1.52-1.97), benzodiazepine alone (aOR, 1.42; 95% CI, 1.21-1.66), and dual use of both (aOR 2.32; 95% CI, 1.94-2.77) within 30 days before the event or index date. Similar odds ratios for respiratory hospitalization risk were found for the use of opioids alone, benzodiazepine alone, and dual use of both in the 60 and 90 days before index date. Obstructive sleep apnea did not show any significant association with single or dual use of the drugs, even after adjustments for positive airway pressure. Individuals with higher degrees of disease complexity experienced greater exacerbations with dual drug use.
Limitations to this study included potential inaccuracies in medical conditions, potential confounding by indication of the correlation between the study medications, the lack of accounting for medications obtained illicitly or from friends, exclusion of certain assessments inherent to the use of claims data, a lack of information on the date a prescription was picked up, a lack of information on multiple risk factors, and a lack of data on positive airway pressure adherence.
The researchers concluded that “patients with COPD and their physicians should judiciously assess the risks and benefits of opioids and benzodiazepines, alone and in combination, and preferentially recommend non-opioid and non-benzodiazepine approaches for pain, sleep, and anxiety management in patients with COPD.”
Disclosures: Drs Baillargeon and Sharma report financial associations with pharmaceutical companies.
Baillargeon J, Singh G, Kuo Y-F, Raji MA, Westra J, Sharma G. Association of opioid and benzodiazepine use with adverse respiratory events in older adults with COPD [published online May 18, 2019]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201901-024OC