Association of Opioid and Benzodiazepine Use with Adverse Respiratory Events in Older Adults with Chronic Obstructive Pulmonary Disease
Association of Opioid and Benzodiazepine Use with Adverse Respiratory Events in Older Adults with Chronic Obstructive Pulmonary Disease
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DOI：
10.1513/annalsats.201901-024oc
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发表时间：
2019-10-01
影响因子：
8.3
通讯作者：
Sharma, Gulshan
中科院分区：
文献类型：
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作者：
Baillargeon, Jacques;Singh, Gurinder;Sharma, Gulshan
依据：患有慢性阻塞性肺疾病（COPD）的老年人发生药物相关不良事件的风险显著增加。两类经常处方的药物对这一患者群体构成特殊风险，即阿片类药物和苯二氮卓类药物。目的：本研究的目的是在老年慢性阻塞性肺疾病（COPD）患者中检测：1）单独或同时使用阿片类药物和苯二氮卓类药物是否与呼吸系统事件住院相关，以及2）阻塞性睡眠呼吸暂停（OSA）的存在是否加剧了这种相关性。方法：我们对年龄≥ 66岁的医疗保险受益人进行了一项病例对照研究，他们在2013年被诊断患有COPD，使用5%的国家医疗保险数据库。例（n = 3，232）定义为2014年因COPD相关呼吸系统诊断住院的患者，并与最多2名对照受试者匹配（n = 6，247）在索引日期、年龄、性别、社会经济状况、合并症、OSA的存在、COPD药物治疗和COPD复杂性方面。与所指对象相比（未使用阿片类药物或苯二氮卓类药物），仅使用阿片类药物（调整后的比值比[aOR 1.73; 95%置信区间[CI]，1.52-1.97），苯二氮卓类药物单独使用（aOR，1.42; 95% CI，1.21-1.66）和事件/索引日期前30天内同时使用阿片类药物/苯二氮卓类药物（aOR，2.32; 95% CI，1.94-2.77）均与因呼吸系统疾病住院的风险增加相关。与单独使用任一药物相比，同时使用阿片类药物和苯二氮卓类药物的住院风险更高。OSA和任何一种药物（单独或联合）之间没有统计学显著的相互作用。然而，在COPD复杂程度较高的患者中，同时使用阿片类药物和苯二氮卓类药物的呼吸系统不良反应增加。所有上述结果持续使用暴露窗口，延长到60和90天前的事件/索引date.Conclusions：在老年COPD患者中，单独或联合使用阿片类药物和苯二氮卓类药物与不良呼吸事件增加相关。这些药物的不良反应在COPD-OSA重叠综合征患者中并未加重。然而，阿片类药物和苯二氮卓类药物双重治疗对高复杂性COPD患者的不良影响更大。
Rationale: Older adults with chronic obstructive pulmonary disease (COPD) are at substantially increased risk for medication-related adverse events. Two frequently prescribed classes of drugs that pose a particular risk to this patient group are opioids and benzodiazepines. Research on this topic has yielded conflicting findings.Objectives: The purpose of this study was to examine, among older adults with COPD, whether: 1) independent or concurrent use of opioid and benzodiazepine medications was associated with hospitalizations for respiratory events, and 2) this association was exacerbated by the presence of obstructive sleep apnea (OSA).Methods: We conducted a case-control study of Medicare beneficiaries aged >= 66 years, who were diagnosed with COPD in 2013, using the 5% national Medicare database. Cases (n = 3,232) were defined as patients hospitalized for a primary COPD-related respiratory diagnosis in 2014 and were matched with up to two control subjects (n = 6,247) on index date, age, sex, socioeconomic status, comorbidity, presence of OSA, COPD medication, and COPD complexity.Results: In comparison to the referent (no opioid or benzodiazepine use), opioid use alone (adjusted odds ratio [aOR 1.73; 95% confidence interval [CI], 1.52-1.97), benzodiazepine use alone (aOR, 1.42; 95% CI, 1.21-1.66), and concurrent opioid/benzodiazepine use (aOR, 2.32; 95% CI, 1.94-2.77) in the 30 days before the event/index date were all associated with an increased risk of hospitalization for a respiratory condition. Risk of hospitalization was higher with concurrent opioid and benzodiazepine use when compared with use of either medication alone. There was no statistically significant interaction between OSA and either of the drugs, alone or in combination. However, the adverse respiratory effects of concurrent opioid and benzodiazepine use were increased in patients with a high degree of COPD complexity. All of the above findings persisted using exposure windows that extended to 60 and 90 days before the event/index date.Conclusions: Among older adults with COPD, use of opioid and benzodiazepine medications alone or in combination were associated with increased adverse respiratory events. The adverse effects of these medications were not exacerbated in patients with COPD-OSA overlap syndrome. However, the adverse impact of dual opioid and benzodiazepine was greater in patients with high-complexity COPD.