Top News in Pulmonology October 12 2018 (7 of 8)

Long-term use of benzodiazepine medications in patients with chronic obstructive pulmonary disease, or COPD, and post-traumatic stress disorder (PTSD) can lead to increased suicide risk, according to a published study in the Annals of the American Thoracic Society.

In "Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder," Lucas M. Donovan, MD, and coauthors report on a study of 44,555 veterans who received medical care between 2010-12. Of these, 23.6% received long-term benzodiazepines (90 days or longer).

Benzodiazepines are commonly prescribed for COPD symptoms, including anxiety, shortness of breath, and insomnia. They are also commonly prescribed to those with PTSD to treat anxiety and insomnia.

Their use for both patients and patients is controversial because of their adverse effects, including an increased risk of COPD exacerbations and self-injury. Many guidelines specifically recommend against their use for patients with COPD or PTSD.

"The use of benzodiazepines among patients with high-risk comorbidities is a frequent dilemma for patients and clinicians," said Dr. Donovan, a pulmonary, critical care, and sleep physician and health services researcher at the VA Puget Sound Healthcare System. "Understanding the risks of benzodiazepines is difficult because they are associated with poor outcomes."

To better understand the risks posed by benzodiazepines, and not just the symptoms they treat, the researchers matched patients in their analysis. These characteristics included medical and psychiatric history, medication use, and health-care utilization.

The researchers found that long-term use of benzodiazepines in patients who also had PTSD more than doubled their risk of suicide. These patients also had higher rates of psychiatric admissions.

Interestingly, the researchers did not find that benzodiazepines in this patient group have increased their risk of death from all causes or respiratory events, as previous studies have suggested.

The researchers found that benzodiazepines were associated with increased mortality, which supports previous findings. Dr. Donovan said that this finding should be interpreted with some caution given the researchers did not use the same matching techniques employed in the primary analyzes.

The authors said study limitations include the possibility of PTSD from medical record data.

"Although long-term benzodiazepine use among patients with COPD and PTSD is not related with overall mortality, the association with suicide is concerning," said Dr. Donovan, who is also an acting instructor at the University of Washington. "More research would be needed to understand suicide, but in the meantime we would advise that clinicians reconsider prescribing benzodiazepines to patients who are already at high risk for self-harm."

-Newswise