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Benzodiazepine Use among Older Adults with Chronic Obstructive Pulmonary Disease

A Population-Based Cohort Study

Drugs & Aging volume 30, pages 183–192 (2013)Cite this article

Abstract

Background

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.

Objective

The purpose of this study was to describe patterns of benzodiazepine use among older adults with COPD.

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgments

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.

Author contributions

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.

Author information

Affiliations

  1. Division of Respirology, Department of Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Nicholas T. Vozoris & Anne L. Stephenson

  2. Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada

    Hadas D. Fischer, Xuesong Wang, Geoffrey M. Anderson, Chaim M. Bell, Andrea S. Gershon, Sudeep S. Gill & Paula A. Rochon

  3. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Nicholas T. Vozoris, Chaim M. Bell, Andrea S. Gershon, Anne L. Stephenson & Paula A. Rochon

  4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Geoffrey M. Anderson, Chaim M. Bell & Paula A. Rochon

  5. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Geoffrey M. Anderson & Paula A. Rochon

  6. Department of Medicine and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Anne L. Stephenson

  7. Department of Medicine, Queen’s University, Kingston, ON, Canada

    Nicholas T. Vozoris & Sudeep S. Gill

  8. Division of Internal Medicine, Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada

    Chaim M. Bell

Authors
  1. Nicholas T. Vozoris
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  2. Hadas D. Fischer
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  3. Xuesong Wang
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  4. Geoffrey M. Anderson
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  6. Andrea S. Gershon
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  7. Anne L. Stephenson
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  8. Sudeep S. Gill
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  9. Paula A. Rochon
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Correspondence to Nicholas T. Vozoris.

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Vozoris, N.T., Fischer, H.D., Wang, X. et al. Benzodiazepine Use among Older Adults with Chronic Obstructive Pulmonary Disease. Drugs Aging 30, 183–192 (2013). https://doi.org/10.1007/s40266-013-0056-1

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  • DOI: https://doi.org/10.1007/s40266-013-0056-1

Keywords

  • Chronic Obstructive Pulmonary Disease
  • Chronic Obstructive Pulmonary Disease Patient
  • Severe Chronic Obstructive Pulmonary Disease
  • Chronic Obstructive Pulmonary Disease Exacerbation
  • Ontario Health Insurance Plan