TY - JOUR T1 - Should we exercise caution with benzodiazepine use in patients with COPD? JF - European Respiratory Journal JO - Eur Respir J SP - 284 LP - 286 DO - 10.1183/09031936.00071014 VL - 44 IS - 2 AU - Robert Rodriguez-Roisin AU - Judith Garcia-Aymerich Y1 - 2014/08/01 UR - http://erj.ersjournals.com/content/44/2/284.abstract N2 - Benzodiazepines are agents that enhance the effect of the neurotransmitter γ-aminobutyric acid (GABA) on the GABAA receptor, resulting in sedative, hypnotic, sleep-inducing, anxiolytic, euphoric, anticonvulsant and muscle-relaxant properties [1]. These properties make benzodiazepines useful in managing anxiety, insomnia, agitation, seizures, muscle spasms and alcohol withdrawal, and as a pre-medication for medical procedures. Benzodiazepines are categorized as short-, intermediate- or long-acting. In general, benzodiazepines are safe and effective in the short term but the elderly are at an increased risk of suffering from both short- and long-term adverse effects.The UK National Institute for Health and Clinical Excellence (NICE) highlights that opioids, benzodiazepines, tricyclic antidepressants and major tranquilisers are useful in palliating symptoms in patients with end-stage chronic obstructive pulmonary disease (COPD) [2]. Furthermore, all these agents, as well as oxygen therapy, should also be used when appropriate for breathlessness in patients with advanced COPD unresponsive to other medical therapy. However, American Thoracic Society/European Respiratory Society guidelines warn against the use of benzodiazepines and recommend avoiding hypnotics, if possible, in patients with severe COPD [3]. According to NICE and in the 2011 revision of the Global Initiative for Obstructive Lung Disease (GOLD) strategy [4], anxiety and depression, irrespective of whether they are considered separately or in combination, are viewed as major comorbidities in COPD and predict poor prognosis [5, 6]. Both are often associated with younger age, female sex, cigarette smoking, more airflow limitation (lower forced expiratory volume in 1 s (FEV1)), cough, worse health-related quality of life and cardiovascular disease antecedents [7]. Furthermore, awareness of shortness of breath is higher in those patients with COPD who have symptoms of anxiety/depression [8]. Anxiety and depressive symptoms are very frequent in patients with COPD and … ER -