Benzodiazepine use in older COPD patients may not be ideal

Chronic obstructive pulmonary disease (COPD) can result in a host of other problems for patients, such as sleeplessness, and depression or anxiety about their condition.

Roughly a third of seniors with COPD have been prescribed benzodiazepines,a commonly used anti-anxiety medication, despite the fact the psychoactive medications are associated with depressed respiratory function and decreased response to carbon dioxide.  This is one insight from new research on the connection between COPD exacerbations and benzodiazepine use.

Many of those benzodiazepine prescriptions went to patients with more severe COPD, and about 30% were dispensed during an exacerbation of the disease, according to the report, published in February in the European Journal Respiratory Journal.

Given the pharmacokinetic and physiological vulnerabilities of those aged over 66 who also have a COPD diagnosis, Nicholas T. Vozoris, MD, a clinical associate at St. Michael’s Hospital in Toronto, and his research team set out to identify what adverse outcomes older adults with COPD might face as a result of benzodiazepine use.

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In Ontario, where the study was conducted, 5% to 10% of the population has been diagnosed with COPD-primarily caused by smoking. Vozoris found that COPD patients that received a new benzodiazepine were 45% more likely to experience an exacerbation of their respiratory symptoms that required outpatient treatment, and they were 92% more likely to require intervention in an emergency department.

“Physicians need to be careful when prescribing these pills and monitor the patients for respiratory side effects,” Vozoris says.

Patients with COPD may be prescribed benzodiazepines for a variety of reasons, including insomnia, depression, anxiety, or refractory dyspnea, Vozoris says. Adverse effects associated with benzodiazepine use in COPD patients, however, can include hypoxemia, decreased respiratory drive, hypercapnea, and decreased respiratory muscle strength.

The study examined a number of benzodiazepines-alprazolam, bromazepam, chlordiazepoxide, clobazam clonazepam, clorazepate, diazepam, flurazepam, lorazepam, nitrazepam, oxazepam, temazepam, and triazolam. Researchers found that benzodiazepine users were at “significantly higher risk” for outpatient respiratory exacerbations, emergency room visits for either COPD or pneumonia, and that hospitalizations among this group compared to non-users was higher.

However, despite this higher relative risk, the absolute risk of developing additional respiratory problems was not clinically significant. But Vozoris notes that in Ontario, the high prevalence of COPD means that even without a large absolute risk, even the relative risk may be clinically important to consider at the population level.

Overall, hospitalizations and pneumonia risks were “significantly elevated” in COPD patients that used benzodiazepines. The study authors also found that evidence that new benzodiazepine users experienced higher mortality risks.

“These findings are concerning, given that benzodiazepines are known to be frequently used among older adults with COPD and in suboptimal ways," Vozoris says. “The findings suggest that the potential for adverse respiratory outcomes needs to be considered when administering benzodiazepines to older adults with COPD.”