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Oct. 12, 2018 – According to a study published online in the US magazine, the long-term use of benzodiazepine-based drugs in patients with chronic obstructive pulmonary disease, or COPD, may result in increased risk of suicide Annals of the American Thoracic Society.
Lucas M. Donovan, MD, and co-authors, present a study of 44,555 veterans who received medical care between 2010 and 12 in "The risks of benzodiazepines in chronic obstructive pulmonary disease with comorbid post-traumatic stress disorder." Of these, 23.6% received long-term benzodiazepines (90 days or more).
Benzodiazepines are commonly prescribed to treat the symptoms of COPD, including anxiety, shortness of breath and insomnia. They are also commonly prescribed to people with PTSD to treat anxiety and insomnia.
Their use for both groups of patients is controversial because of unwanted side effects, including an increased risk of exacerbations of COPD and self-harm. Many guidelines specifically recommend that they not be used in patients with COPD or PTSD.
"The use of benzodiazepines in patients with high-risk comorbidities is a frequent dilemma for patients and clinicians," said Dr. Donovan, a specialist in severe diseases, sleep, and sleep care at the VA. Puget Sound Healthcare System. "Understanding the risks associated with benzodiazepines is difficult because the symptoms that encourage them to use, including anxiety and shortness of breath, are themselves linked to poor results."
To better understand the risks posed by benzodiazepines, and not just the symptoms they treat, the researchers compared patients to their analysis by taking into account more than 44 patient characteristics. These features included medical and psychiatric history, the use of medications and the use of health care.
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The researchers found that the long-term use of benzodiazepines in COPD patients also suffering from PTSD more than doubled their risk of suicide. These patients also had higher rates of admission to psychiatry.
Interestingly, the researchers did not find that the long-term use of benzodiazepines in this group of patients increased their risk of death from all causes or from respiratory events, as suggested by previous studies .
The researchers found that short-term use (less than 90 days) of benzodiazepines was associated with increased mortality, which corroborates earlier findings. Donovan said this finding should be interpreted with some caution, as researchers did not use the same linkage techniques as those used in the main analyzes.
The authors stated that the limitations of the study include the possibility of not being able to fully determine the severity of pulmonary obstruction or PTSD from the medical record data.
"Although the long-term use of benzodiazepines in patients with COPD and PTSD is not related to overall mortality, the association with suicide is of concern," said Dr. Donovan, also an instructor. Interim at the University of Washington. "Further research will be needed to better understand this link with suicide, but at the same time, we advise clinicians to reconsider the prescription of benzodiazepines to patients who are already at high risk of self-harm."
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