苯二氮卓类与老年慢性阻塞性肺疾病患者病情恶化有关

《欧洲呼吸杂志》4月17日在线发表的一项研究显示，苯二氮卓的使用与老年慢性阻塞性肺病（COPD）患者的不良呼吸结局风险显著增加有关（Eur. Respir. J. 2014 April 17 [doi: 10.1183/09031936.00008014]）。

主要研究者、多伦多大学St. Michael医院的Nicholas Vozoris博士报告称，与不使用苯二氮卓的患者相比，新使用苯二氮卓的患者接受门诊呼吸系统药物的几率增加45%，因呼吸系统原因前往急诊科就诊的几率增加92%。

在这项基于人群的回顾性队列研究中，研究者对2003~2010年期间加拿大安大略省177,355例年龄≥66岁的COPD患者进行了分析。结果显示，新使用苯二氮卓类药物的患者明显更可能被开具口服皮质激素或呼吸系统抗生素处方（相对风险，1.45；95%可信区间：1.36~1.54），因COPD或肺炎前往急诊科就诊的可能性也更大[相对风险（RR），1.92；95%可信区间（CI）：1.69~2.18]。

此外，在入组前1年内未出现COPD急性加重的亚组患者中，新使用苯二氮卓的患者接受门诊呼吸系统药物（RR，1.63；95% CI：1.44~1.84）、因COPD或肺炎前往急诊科就诊（RR，2.46；95% CI：1.90~3.18）、因COPD或肺炎住院（RR，1.29；95% CI：1.07~1.56）或全因死亡（RR，1.19；95% CI：1.06~1.34）的几率明显更高。

Vozoris博士及其同事指出：“鉴于老年COPD患者常常使用苯二氮卓类药物且常常以不合理的方式使用，上述结果令人担忧，提示我们有必要在对老年COPD患者使用苯二氮卓类药物时考虑到不良呼吸结局的可能性。”

研究者还表示，上述研究结果与既往规模较小、时间较短的研究结果是一致的。不过他们采用的COPD定义的敏感性仅有58%，这可能限制其研究结果的普适性。

 加拿大卫生研究院和临床评价科学研究所资助了这项研究。研究者报告称无相关利益冲突。

 专家点评：呼吸科医生必须非常谨慎地使用苯二氮卓类药物

Daniel R. Ouellette博士

Daniel Ouellette博士评论：近年来，“COPD是一种呼吸疾病”的旧观念已被“COPD是一种多系统障碍”的新概念取代。神经精神异常在COPD患者中很常见。治疗COPD患者的呼吸科医生常会发现重度呼吸疾病患者合并焦虑障碍。

近期一些研究表明，采用苯二氮卓类药物治疗COPD与不良呼吸结局有关。显然，呼吸科医生必须在对COPD 患者开具此类药物处方时必须非常谨慎。

尽管这项回顾性分析采用了一些统计学方法校正其他变量，但仍然有悬而未决的问题：使用苯二氮卓类药物的COPD患者的呼吸结局比不用此类药物的患者更差，这是治疗引起的吗？或是潜在疾病的差异导致的吗？

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By:  AMY KARON, Frontline Medical News |

 05/09/14

FROM THE EUROPEAN RESPIRATORY JOURNAL

Vitals

Major finding: Compared with nonusers, new users of benzodiazepines were significantly more likely to be prescribed oral corticosteroids or respiratory antibiotics (RR, 1.45; 95% CI, 1.36-1.54) and to visit the emergency department for COPD or pneumonia (RR, 1.92; 95% CI, 1.69-2.18).

Data source: Retrospective population-based cohort study of 177,355 adults with COPD who were aged 66 years or older and lived in Ontario, Canada, during 2003-2010.

Disclosures: The Canadian Institutes of Health and the Institute for Clinical Evaluative Sciences funded the study. The investigators reported having no relevant conflicts of interest.

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Respiratory physicians must use great care in prescribing benzodiazepines

 

Benzodiazepine use is associated with significantly increased risks of adverse respiratory outcomes in older adults with chronic obstructive pulmonary disease, researchers reported online April 17 in the European Respiratory Journal.

New benzodiazepine users were 45% more likely to receive outpatient respiratory medications and 92% more likely to visit the emergency department for respiratory reasons than were non–benzodiazepine users, reported Dr. Nicholas Vozoris of St. Michael’s Hospital and the University of Toronto and his associates.

"These findings are concerning, given that benzodiazepines are known to be frequently used among older adults with COPD and in suboptimal ways," the investigators wrote. "The findings suggest that the potential for adverse respiratory outcomes needs to be considered when administering benzodiazepines to older adults with COPD."

The retrospective population-based cohort study identified 177,355 adults with COPD who were at least 66 years old and lived in Ontario, Canada, during 2003-2010. The researchers used 1:1 propensity score matching without replacement to match 48,915 new benzodiazepine users with the same number of nonusers (Eur. Respir. J. 2014 April 17 [doi: 10.1183/09031936.00008014]).

New users of benzodiazepines were significantly more likely to be prescribed oral corticosteroids or respiratory antibiotics (relative risk, 1.45; 95% confidence interval, 1.36-1.54) and to visit the emergency department for COPD or pneumonia (RR, 1.92; 95% CI, 1.69-2.18).

Furthermore, in the subgroup of patients who had no exacerbation of COPD during the year before baseline, new benzodiazepine users had a significantly greater risk of receiving outpatient respiratory medications (RR, 1.63; 95% CI, 1.44-1.84), visiting an emergency department for COPD or pneumonia (RR, 2.46; 95% CI, 1.90-3.18), being hospitalized for either diagnosis (RR, 1.29; 95% CI, 1.07-1.56), or dying from any cause (RR, 1.19, 95% CI, 1.06-1.34).

The research is consistent with findings from previous smaller, shorter-duration studies, said Dr. Vozoris and his associates. They noted that their definition of COPD had a sensitivity of only 58%, which could limit the generalizability of the findings.

The Canadian Institutes of Health and the Institute for Clinical Evaluative Sciences funded the study. The investigators reported having no conflicts of interest.

 

Respiratory physicians must use great care in prescribing benzodiazepines

Dr. Daniel Ouellette, FCCP, comments: The old paradigm of COPD as a respiratory illness has been replaced in recent years by the concept of COPD as a multisystem disorder. Neuropsychiatric conditions are commonplace among patients with COPD. Pulmonologists caring for patients with COPD frequently encounter anxiety disorders among their patients with severe respiratory disease.

Recent studies now indicate that treatment of COPD patients with benzodiazepines is associated with adverse respiratory outcomes. Clearly, respiratory physicians must use great care in prescribing such agents for their patients with COPD.

Although statistical methods were used to control for other variables in this retrospective analysis, the question remains: Are the worse respiratory outcomes in COPD patients taking benzodiazepines when compared to those not taking these agents an effect of the treatment or an effect of differences in the underlying illness?