Benzodiazepine Use among Older Adults with Chronic Obstructive Pulmonary Disease
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Patients with chronic obstructive pulmonary disease (COPD) may receive benzodiazepines for a variety of reasons, including as treatment for insomnia, as treatment for depression and anxiety, and to help relieve refractory dyspnoea. However, benzodiazepines have been linked to adverse physiological respiratory outcomes in individuals with COPD. The potential adverse respiratory effects of benzodiazepines in COPD may also be heightened in older adults given their altered pharmacokinetics that increase benzodiazepine half-life. There is minimal information on the scope and nature of benzodiazepine use in the older adult COPD population.
The purpose of this study was to describe patterns of benzodiazepine use among older adults with COPD.
A validated algorithm was applied to Ontario healthcare administrative data to identify older adults with COPD. Incident oral benzodiazepine receipt between 1 April 2004 and 31 March 2009, defined as no benzodiazepines dispensed in the year prior to incident prescription, was examined. Regression techniques were used to identify patient characteristics associated with new benzodiazepine use. Descriptive statistics were performed to describe benzodiazepine use among new users. The analysis was stratified by COPD severity defined by COPD exacerbation frequency (less severe COPD: 0 exacerbations in the year prior; more severe COPD: 1 or more exacerbations in the year prior).
Among 111,445 older adults with COPD, 35,311 (31.7 %) received a new benzodiazepine. New benzodiazepine receipt was higher among individuals with more severe COPD (adjusted odds ratio 1.43, 95 % CI 1.38–1.48). Among new benzodiazepine users, there was a relatively high frequency of receipt of long-acting agents (14.6 %), dispensations for greater than 30 days (32.6 %), second dispensations (22.0 % or 30.6 % for occurrence within 120 % or 200 % days of the index prescription, respectively), early refills (11.6 %), and benzodiazepine receipt during COPD exacerbations (9.0 %). Among individuals with more severe COPD, 35.4 % of incident use occurred during a COPD exacerbation.
Almost one-third of older individuals with COPD received a new benzodiazepine, and rates were higher among those with more severe COPD. Important safety and quality of care issues are potentially raised by the degree and pattern of benzodiazepine use in this older and respiratory-vulnerable population.
KeywordsChronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Severe Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Exacerbation Ontario Health Insurance Plan
This study was conducted at the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
Conflicts of interest and funding
This study was funded by a Team Grant (OTG-88591) from the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes. The funder had no role in the study design; in the collection, analysis and interpretation of data; or in the writing of the article and the decision to submit it for publication. All authors are independent from the funders.
All authors had access to all the data presented. Conception and design: N.T.V., H.D.F., G.M.A., C.M.B., A.S.G., A.L.S., S.S.G. and P.A.R.; analysis and interpretation: N.T.V., H.D.F., X.W., G.M.A., C.M.B., A.S.G., A.L.S., S.S.G. and P.A.R.; and drafting the manuscript for important intellectual content: N.T.V., H.D.F., X.W., G.M.A., C.M.B., A.S.G., A.L.S., S.S.G. and P.A.R.
- 2.Jolly E, Aguirre L, Jorge E, et al. Acute effect of lorazepam on respiratory muscles in stable patients with chronic obstructive pulmonary disease. [Article in Spanish]. Medicina (B Aires). 1996;56:472–8.Google Scholar
- 28.Marciniuk D, Goodridge D, Hernandez P, Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group, et al. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011;18:69–78.PubMedGoogle Scholar
- 30.Levy R, O’Brien BJ, Sellors C, et al. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Pharmacol. 2003;10:67–71.Google Scholar
- 33.Connors AF Jr, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154:959–67.PubMedCrossRefGoogle Scholar
- 35.O’Donnell DE, Hernandez P, Kaplan A, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2008 update: highlights for primary care. Can Resp J. 2008;15S:1A–8A.Google Scholar
- 36.Canadian Pharmacists Association. Compendium of pharmaceuticals and specialties. Ottawa: The Canadian Drug Reference for Health Professionals. Canadian Pharmacists Association; 2008.Google Scholar
- 38.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2011. http://www.goldcopd.org.
- 43.The American Geriatrics Society 2012 Beers Criteria Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.Google Scholar