Safety of benzodiazepines and opioids in very severe respiratory disease: National prospective study

Ekström, MP; Bornefalk-Hermansson, A; Abernethy, AP; Currow, DC

Safety of benzodiazepines and opioids in very severe respiratory disease: National prospective study

Ekström, MP Bornefalk-Hermansson, A Abernethy, AP Currow, DC

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Publication Type:: Journal Article
Citation:: BMJ (Online), 2014, 348
Issue Date:: 2014-01-30

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Field	Value	Language
dc.contributor.author	Ekström, MP	en_US
dc.contributor.author	Bornefalk-Hermansson, A	en_US
dc.contributor.author	Abernethy, AP	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.date.issued	2014-01-30	en_US
dc.identifier.citation	BMJ (Online), 2014, 348	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118978
dc.description.abstract	Objective: To evaluate the safety of benzodiazepines and opioids in patients with very severe chronic obstructive pulmonary disease (COPD). Design: Population based longitudinal consecutive cohort study. Setting: Centres prescribing long term oxygen therapy in Sweden. Patients: 2249 patients starting long term oxygen therapy for COPD in Sweden between 2005 and 2009 in the national Swedevox Register. Main outcome measures: Effects of benzodiazepines and opioids on rates of admission to hospital and mortality, adjusted for age, sex, arterial blood gases, body mass index (BMI), performance status, previous admissions, comorbidities, and concurrent drugs. Results: 1681 (76%) patients were admitted to hospital, and 1129 (50%) died under observation. No patient was lost to follow-up. Benzodiazepines and opioids were not associated with increased admission: hazard ratio 0.98 (95% confidence interval, 0.87 to 1.10) and 0.98 (0.86 to 1.10), respectively. Benzodiazepines were associated with increased mortality (1.21, 1.05 to 1.39) with a dose response trend. Opioids also had a dose response relation with mortality: lower dose opioids (≤30 mg oral morphine equivalents a day) were not associated with increased mortality (1.03, 0.84 to 1.26) in contrast with higher dose opioids (1.21, 1.02 to 1.44). Concurrent benzodiazepines and opioids in lower doses were not associated with increased admissions (0.86, 0.53 to 1.42) or mortality (1.25, 0.78 to 1.99). Associations were not modified by being naive to the drugs or by hypercapnia. Conclusions: Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease.	en_US
dc.relation.ispartof	BMJ (Online)	en_US
dc.relation.isbasedon	10.1136/bmj.g445	en_US
dc.subject.classification	General & Internal Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive	en_US
dc.subject.mesh	Benzodiazepines	en_US
dc.subject.mesh	Analgesics, Opioid	en_US
dc.subject.mesh	Hospitalization	en_US
dc.subject.mesh	Follow-Up Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Outcome Assessment (Health Care)	en_US
dc.subject.mesh	Sweden	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Outcome Assessment, Health Care	en_US
dc.title	Safety of benzodiazepines and opioids in very severe respiratory disease: National prospective study	en_US
dc.type	Journal Article
utslib.citation.volume	348	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.publication-status	Published	en_US
pubs.volume	348	en_US

Abstract:

Objective: To evaluate the safety of benzodiazepines and opioids in patients with very severe chronic obstructive pulmonary disease (COPD). Design: Population based longitudinal consecutive cohort study. Setting: Centres prescribing long term oxygen therapy in Sweden. Patients: 2249 patients starting long term oxygen therapy for COPD in Sweden between 2005 and 2009 in the national Swedevox Register. Main outcome measures: Effects of benzodiazepines and opioids on rates of admission to hospital and mortality, adjusted for age, sex, arterial blood gases, body mass index (BMI), performance status, previous admissions, comorbidities, and concurrent drugs. Results: 1681 (76%) patients were admitted to hospital, and 1129 (50%) died under observation. No patient was lost to follow-up. Benzodiazepines and opioids were not associated with increased admission: hazard ratio 0.98 (95% confidence interval, 0.87 to 1.10) and 0.98 (0.86 to 1.10), respectively. Benzodiazepines were associated with increased mortality (1.21, 1.05 to 1.39) with a dose response trend. Opioids also had a dose response relation with mortality: lower dose opioids (≤30 mg oral morphine equivalents a day) were not associated with increased mortality (1.03, 0.84 to 1.26) in contrast with higher dose opioids (1.21, 1.02 to 1.44). Concurrent benzodiazepines and opioids in lower doses were not associated with increased admissions (0.86, 0.53 to 1.42) or mortality (1.25, 0.78 to 1.99). Associations were not modified by being naive to the drugs or by hypercapnia. Conclusions: Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease.

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http://hdl.handle.net/10453/118978