Long-term Benzodiazepine Use May Increase COPD Patients’ Suicide Risk, Study Suggests

Iqra Mumal, MSc avatar

by Iqra Mumal, MSc |

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COPD and low-dose morphine

Patients with chronic obstructive pulmonary disease (COPD) on long-term treatment with benzodiazepines are at a higher risk for suicide, a study suggests.

The study, “Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder,” was published in the journal Annals of the American Thoracic Society.

Benzodiazepines are anxiety-reducing, hypnotic, sedative, and anticonvulsant drugs that act rapidly. COPD patients may be administered benzodiazepines for a variety of reasons, such as treatment for insomnia, depression or anxiety, or to help relieve refractory dyspnea (breathing difficulty that persists at rest or with minimal activity).

The use of benzodiazepines by COPD patients is controversial because of adverse side effects, including an increased risk of COPD exacerbations and self-injury.

“The use of benzodiazepines among patients with high-risk comorbidities is a frequent dilemma for patients and clinicians,” Lucas Donovan, MD, a pulmonary, critical care and sleep physician and health services researcher at the VA Puget Sound Healthcare System, and the study’s lead author, said in a press release.

“Understanding the risks of benzodiazepines is difficult because the symptoms that prompt their use, including anxiety and shortness of breath, are themselves linked with poor outcomes,” Donovan said.

Therefore, researchers set out to assess the mortality risk of long-term benzodiazepine use among patients with COPD and comorbid post-traumatic stress disorder (PTSD). Researchers used a 2010-12 database from the Veteran’s Health Administration to identify all patients with COPD and PTSD.

Researchers calculated scores for benzodiazepine use, and compared overall and cause-specific mortality in patients who had long-term (defined as greater than or equal to 90 days) benzodiazepine use, compared to matched patients who reported no use of benzodiazepines.

Among 44,555 veterans with COPD and co-morbid PTSD, 23.6% received benzodiazepines long-term.

When patients with and without long-term use of benzodiazepine were compared, researchers observed no difference in mortality rates. However, short-term benzodiazepine use was associated with an increased mortality (1.16 times higher).

“Risks for respiratory compromise related to long-term benzodiazepine use in COPD may be less than previously estimated, but short-term use of benzodiazepines could still pose a mortality risk,” the researchers said.

Upon evaluating cause-specific mortality, researchers found that patients on long-term benzodiazepine use were at 2.33 times higher risk of death by suicide.

“Although long-term benzodiazepine use among patients with COPD and PTSD is not linked with overall mortality, the association with suicide is concerning,” Donovan said. “More research will be needed to better understand this link with suicide, but in the meantime we would advise that clinicians reconsider prescribing benzodiazepines to patients who already are at high risk for self-harm.”