Abstract
Purpose: Many comorbidities, including depression, anxiety, and insomnia, occur in patients with chronic obstructive pulmonary disease (COPD). These patients may be prescribed benzodiazepines (BZDs). However, there are some concerns that benzodiazepines increase the risk of drug overdose, hypercapnic respiratory failure, acute exacerbation and increased mortality. The aim of our study was to evaluate the drug safety of BZDs in patients with COPD. Methods: We used the National Health Insurance Research database in Taiwan from 2002 to 2016 to perform a retrospective cohort study. We enrolled patients who were exposed to the first prescription of BZDs, non-BZDs or a combination (mix user) after COPD diagnosis. We performed 1:1:1 propensity score matching in three groups. The outcomes were COPD with acute exacerbation and all-cause mortality. Poisson regression analysis was performed to evaluate the incidence rate ratios for the outcomes in the groups. Results: After propensity score matching, there were 2,856 patients in each group. After adjusting for confounding factors, we found that compared to BZD users, non-BZD and mix users had nonsignificant differences in outpatient management of acute exacerbations, hospitalization management of acute exacerbations, emergency department management of acute exacerbations and all-cause mortality. BZD and mix groups showed significantly increased admission for acute exacerbation of COPD compared with that of the nonuser group, with IRRs of 2.52 (95% CI, 1.52–4.18; p = 0.0004) and 2.63 (95% CI, 1.57–4.40; p = 0.0002), respectively. Conclusion: BZD, non-BZD, and mix users showed increased COPD-related respiratory events compared to nonusers in Asian subjects.
Highlights
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that is not fully reversible and is characterized by airflow obstruction
267,741 patients were included in the COPD cohort (Figure 1), of whom 82,675 were first prescribed Benzodiazepine receptor agonists (BZRAs) drugs after their COPD diagnosis
According to our insurance regulation, benzodiazepines are used for a range of some health issues, including anxiety, sleep disorders, and epilepsy
Summary
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that is not fully reversible and is characterized by airflow obstruction. COPD is associated with a substantial health burden worldwide (Soriano and Rodriguez-Roisin, 2011; World Health Organization 2017; Terzano et al, 2010; Decramer et al, 2012). Comorbidities such as insomnia, anxiety, sleep disorder, depression, and psychological disorders are commonly reported in patients with COPD (Light et al, 1985; Kunik et al, 2005; Solano et al, 2006; Cheng et al, 2008; Maurer et al, 2008; Biswas et al, 2017). The risk may increase as the plasma half-life of BZDs increases (Greenblatt et al, 1991; Fisher, 1999)
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