Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD

To the Editor:

We read with interest the recent article by Vozoris et al. [1], who suggest that benzodiazepine drug use had adverse respiratory outcomes among older adults with chronic obstructive lung disease (COPD). Many studies are in support of this study but we cannot neglect the opposing studies which did not show any adverse effects of benzodiazepines in patients with COPD [2, 3]. American Thoracic Society/European Respiratory Society guidelines [4] state that hypnotics should not be given in patients with “severe” COPD. It would be better if the authors could stage COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. Studies of lower dose benzodiazepines and lower dose opioids in patients with COPD were not associated with increased admissions [5].

The prevalence of insomnia in COPD patients is ∼50% [6], which has a negative impact on the quality of life of these patients. Therefore, the quality of life of COPD patients can be improved by improving sleep quality and anxiety. Although there is no relationship of problems associated with sleep with lung function [6–8], there may be a relationship between the frequency and severity of pulmonary symptoms [6].

Benzodiazepines differ from each other by their duration of action and pharmacokinetics, and can be divided into short-, intermediate- or long-acting agents. One study showed that a long-acting benzodiazepine had more adverse effects on the respiratory system than a short-acting benzodiazepine [9].

We agree with the authors that strict vigilance on adverse effects of benzodiazepines in older COPD patients is required, as this group of patients have altered pharmacokinetics due to the presence of comorbid conditions, as well as medications for these conditions that may affect metabolism of benzodiazepines. In addition, short-acting benzodiazepines in adequate doses can improve quality of life in elderly patients.