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

Rahul Katyal
European Respiratory Journal 2015 45: 565-566; DOI: 10.1183/09031936.00160514
Rahul Katyal
Dept of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India
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Abstract

Short-acting benzodiazepines can be safely used in COPD and might improve quality of life in the elderly http://ow.ly/DgvXw

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.

Footnotes

  • Conflict of interest: None declared.

  • Received September 1, 2014.
  • Accepted September 4, 2014.
  • Copyright ©ERS 2015

References

  1. ↵
    1. Vozoris NT,
    2. Fischer HD,
    3. Wang X, et al.
    Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J 2014; 44: 332–340.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Midgren B,
    2. Hansson L,
    3. Skeidsvoll H, et al.
    The effects of nitrazepam and flunitrazepam on oxygen desaturation during sleep in patients with stable hypoxemic nonhypercapnic COPD. Chest 1989; 95: 765–768.
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    1. Wedzicha JA,
    2. Wallis PJ,
    3. Ingram DA, et al.
    Effect of diazepam on sleep in patients with chronic airflow obstruction. Thorax 1988; 43: 729–730.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Celli BR,
    2. MacNee W
    , ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932–946.
    OpenUrlFREE Full Text
  5. ↵
    1. Klink ME,
    2. Dodge R,
    3. Quan SF
    . The relation of sleep complaints to respiratory symptoms in a general population. Chest 1994; 105: 151–154.
    OpenUrlCrossRefPubMedWeb of Science
  6. ↵
    1. Klink M,
    2. Quan SF
    . Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 1987; 91: 540–546.
    OpenUrlCrossRefPubMedWeb of Science
    1. Kinsman RA,
    2. Yaroush RA,
    3. Fernandez E, et al.
    Symptoms and experiences in chronic bronchitis and emphysema. Chest 1983; 83: 755–761.
    OpenUrlCrossRefPubMedWeb of Science
  7. ↵
    1. Fleetham J,
    2. West P,
    3. Mezon B, et al.
    Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy. Am Rev Respir Dis 1982; 126: 429–433.
    OpenUrlPubMedWeb of Science
  8. ↵
    1. Murciano D,
    2. Armengaud MH,
    3. Cramer PH, et al.
    Acute effects of zolpidem, triazolam and flunitrazepam on arterial blood gases and control of breathing in severe COPD. Eur Respir J 1993; 6: 625–629.
    OpenUrlAbstract/FREE Full Text
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Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD
Rahul Katyal
European Respiratory Journal Feb 2015, 45 (2) 565-566; DOI: 10.1183/09031936.00160514

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Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD
Rahul Katyal
European Respiratory Journal Feb 2015, 45 (2) 565-566; DOI: 10.1183/09031936.00160514
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