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Yang R, Zhao R, Chaudry F, Wang T, Brunton P, Khurshid Z, Ratnayake J. Modern sedative agents and techniques used in dentistry for patients with special needs: A review. J Taibah Univ Med Sci 2024; 19:153-163. [PMID: 38047240 PMCID: PMC10692720 DOI: 10.1016/j.jtumed.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023] Open
Abstract
According to the World Health Organisation, approximately 1.3 billion people worldwide experience substantial disability due to physical, mental or sensory impairment. People with special needs require special consideration and more time or altered delivery methods when receiving dental treatments. Various factors, such as patients' lack of cooperation, cognitive impairment and complex medical status, may lead dental practitioners to recommend conscious sedation. Several pharmacological agents and administrative routes are available, which achieve varying levels of sedation ranging from minimal to deep. Pre-operative assessment and careful case selection are necessary to determine the appropriate sedative agent, route of administration and level of sedation for each patient. Thus, a thorough understanding of the pharmacokinetics, risks and benefits, and implications of various sedatives available for PSN is essential to achieve the desired clinical outcomes. This review critically presents the considerations associated with the use of various sedative agents for PSN in dentistry. Considerations include patients' pre-anaesthesia medical comorbidities, cardiorespiratory adverse effects and cooperativeness, and the viable alternative treatment modalities.
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Affiliation(s)
- Ruijia Yang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rusin Zhao
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Fatima Chaudry
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Tao Wang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Paul Brunton
- Department of Prosthodontics and Dental Implantology, Curtin University, Bentley, Australia
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, KSA
| | - Jithendra Ratnayake
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Sood A, Kuo YF, Westra J, Sharma G, Raji MA. Co-prescribing of Central Nervous System-Active Medications for COPD Patients: Impact on Emergency Room Visits and Hospitalization. Ann Pharmacother 2023; 57:382-396. [PMID: 35942598 PMCID: PMC10508332 DOI: 10.1177/10600280221113299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anxiety and chronic pain are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which are frequently managed with benzodiazepines (BZDs) and opioids, respectively. OBJECTIVE The purpose of this study was to determine whether different combinations of opioids, BZD, and their substitutes-gabapentinoids (GABA) and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs)-are associated with lower risk of acute respiratory events in COPD patients with co-occurring chronic pain and anxiety. METHODS This retrospective cohort study used a nationally representative sample of Medicare beneficiaries with COPD, chronic pain, and anxiety. Patients were grouped based on drug combination (opioid + BZD/Z-hypnotics, opioid + GABA, opioid + SSRI/SNRI, BZD/Z-hypnotics + GABA, BZD/Z-hypnotics + SSRI/SNRI, GABA + SSRI/SNRI, or ≥3 drugs). The primary outcome was emergency room (ER) visit or hospitalization due to acute respiratory events assessed up to 180 days following initiation of drug combination. Overdose secondary to central nervous system (CNS)-related drugs was also assessed up to 180 days following initiation of drug combination. RESULTS The drug combination opioid + GABA was associated with decreased risk for ER visit (hazard ratio [HR] = 0.73; 95% CI = 0.61-0.87) and hospitalization (HR = 0.69; 95% CI = 0.55-0.85). Opioid + SSRI/SNRI also showed decreased risk for ER visit (HR = 0.84; 95% CI = 0.71-0.99). There was no significant difference in risk for CNS-related drug overdose among different drug combinations compared with opioid + BZD/Z-hypnotics. CONCLUSION AND RELEVANCE Opioids in combination with GABA and SSRI/SNRI demonstrate relatively lower risk for acute respiratory events among patients with COPD and comorbid chronic pain and anxiety. The findings emphasize the need for multimodal management in this vulnerable population.
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Affiliation(s)
- Akhil Sood
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Gulshan Sharma
- Department of Pulmonary, Critical Care, & Sleep Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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Luyster FS, Boudreaux-Kelly MY, Bon JM. Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs. Respir Res 2023; 24:93. [PMID: 36964552 PMCID: PMC10039604 DOI: 10.1186/s12931-023-02401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria St, 415 Victoria Building, Pittsburgh, PA, 15241, USA.
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | - Jessica M Bon
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Kinney KL, Zheng Y, Morris MC, Schumacher JA, Bhardwaj SB, Rowlett JK. Predicting benzodiazepine prescriptions: A proof-of-concept machine learning approach. Front Psychiatry 2023; 14:1087879. [PMID: 36970256 PMCID: PMC10036348 DOI: 10.3389/fpsyt.2023.1087879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Benzodiazepines are the most commonly prescribed psychotropic medications, but they may place users at risk of serious adverse effects. Developing a method to predict benzodiazepine prescriptions could assist in prevention efforts. Methods The present study applies machine learning methods to de-identified electronic health record data, in order to develop algorithms for predicting benzodiazepine prescription receipt (yes/no) and number of benzodiazepine prescriptions (0, 1, 2+) at a given encounter. Support-vector machine (SVM) and random forest (RF) approaches were applied to outpatient psychiatry, family medicine, and geriatric medicine data from a large academic medical center. The training sample comprised encounters taking place between January 2020 and December 2021 (N = 204,723 encounters); the testing sample comprised data from encounters taking place between January and March 2022 (N = 28,631 encounters). The following empirically-supported features were evaluated: anxiety and sleep disorders (primary anxiety diagnosis, any anxiety diagnosis, primary sleep diagnosis, any sleep diagnosis), demographic characteristics (age, gender, race), medications (opioid prescription, number of opioid prescriptions, antidepressant prescription, antipsychotic prescription), other clinical variables (mood disorder, psychotic disorder, neurocognitive disorder, prescriber specialty), and insurance status (any insurance, type of insurance). We took a step-wise approach to developing a prediction model, wherein Model 1 included only anxiety and sleep diagnoses, and each subsequent model included an additional group of features. Results For predicting benzodiazepine prescription receipt (yes/no), all models showed good to excellent overall accuracy and area under the receiver operating characteristic curve (AUC) for both SVM (Accuracy = 0.868-0.883; AUC = 0.864-0.924) and RF (Accuracy = 0.860-0.887; AUC = 0.877-0.953). Overall accuracy was also high for predicting number of benzodiazepine prescriptions (0, 1, 2+) for both SVM (Accuracy = 0.861-0.877) and RF (Accuracy = 0.846-0.878). Discussion Results suggest SVM and RF algorithms can accurately classify individuals who receive a benzodiazepine prescription and can separate patients by the number of benzodiazepine prescriptions received at a given encounter. If replicated, these predictive models could inform system-level interventions to reduce the public health burden of benzodiazepines.
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Affiliation(s)
- Kerry L. Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Yufeng Zheng
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Julie A. Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - Saurabh B. Bhardwaj
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
| | - James K. Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, United States
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Eliasson G, Janson C, Johansson G, Larsson K, Lindén A, Löfdahl CG, Sandström T, Sundh J. Comorbid conditions as predictors of mortality in severe COPD - an eight-year follow-up cohort study. Eur Clin Respir J 2023; 10:2181291. [PMID: 36861117 PMCID: PMC9970194 DOI: 10.1080/20018525.2023.2181291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Purpose Co-morbidities are common in chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. The aim of the present study was to explore the prevalence of several comorbid conditions in severe COPD, and to investigate and compare their associations with long-term mortality. Methods In May 2011 to March 2012, 241 patients with COPD stage 3 or 4 were included in the study. Information was collected on sex, age, smoking history, weight and height, current pharmacological treatment, number of exacerbations the recent year and comorbid conditions. At December 31st, 2019, mortality data (all-cause and cause specific) were collected from the National Cause of Death Register. Data were analyzed using Cox-regression analysis with gender, age, previously established predictors of mortality and comorbid conditions as independent variables, and all-cause mortality and cardiac and respiratory mortality, respectively, as dependent variables. Results Out of 241 patients, 155 (64%) were deceased at the end of the study period; 103 patients (66%) died of respiratory disease and 25 (16%) of cardiovascular disease. Impaired kidney function was the only comorbid condition independently associated with increased all-cause mortality (HR (95% CI) 3.41 (1.47-7.93) p=0.004) and respiratory mortality (HR (95%CI) 4.63 (1.61 to 13.4), p = 0.005). In addition, age ≥70, BMI <22 and lower FEV1 expressed as %predicted were significantly associated with increased all-cause and respiratory mortality. Conclusion In addition to the risk factors high age, low BMI and poor lung function; impaired kidney function appears to be an important risk factor for mortality in the long term, which should be taken into account in the medical care of patients with severe COPD.
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Affiliation(s)
- Gabriella Eliasson
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,CONTACT Gabriella Eliasson Department of Respiratory medicine, Örebro University Hospital, Södra Grevrosengatan, ÖrebroS-701 85, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory; Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Kjell Larsson
- Division for Lung and Airway Research, Institute of Environmental Medicine, Stockholm, Sweden
| | - Anders Lindén
- Division for Lung and Airway Research, Institute of Environmental Medicine, Stockholm, Sweden,Karolinska Severe COPD Center, Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Claes-Göran Löfdahl
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Simon ST, Mori M, Ekström M, Pralong A, Yamaguchi T, Hui D. Should Benzodiazepines be Used for Reducing Dyspnea in Patients with Advanced Illnesses? J Pain Symptom Manage 2023; 65:e219-e223. [PMID: 36455801 DOI: 10.1016/j.jpainsymman.2022.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022]
Abstract
Dyspnea is a common and highly distressing symptom in patients with advanced illnesses. Many patients continue to experience chronic dyspnea despite optimal management of underlying disease(s) and various non-pharmacologic interventions, necessitating the consideration of pharmacologic therapies for palliation of dyspnea. One commonly asked question by clinicians is whether benzodiazepines have a role in the palliation of dyspnea. In this "Controversies in Palliative Care" article, three groups of thought leaders independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. All three groups suggest that benzodiazepines alone do not confer a benefit for dyspnea in advanced illnesses based on existing data. They also expressed concerns about the potential adverse effects such as delirium and drowsiness and recommended against benzodiazepines as first line pharmacologic therapy. Some groups suggest that benzodiazepines may be used in highly selected patients with severe anxiety associated with dyspnea. Some investigators may also consider the adjunctive use of benzodiazepines in patients with severe dyspnea despite opioids, particularly if life expectancy is limited. Benzodiazepines also have a role in palliative sedation for refractory dyspnea in the last days of life. More research is needed to confirm the benefit of benzodiazepines in these populations.
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Affiliation(s)
- Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
| | - Masanori Mori
- Palliative and Supportive Care Division (M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Magnus Ekström
- Respiratory Medicine, Allergology, and Palliative Medicine (M.E.), Lund University, Sweden
| | - Anne Pralong
- Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
| | - Takashi Yamaguchi
- Department of Palliative Medicine (T.Y.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine (D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas.
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A nationwide cohort study of the association of benzodiazepines with SARS-CoV-2 infection and clinical outcomes. Sci Rep 2022; 12:15947. [PMID: 36153398 PMCID: PMC9509375 DOI: 10.1038/s41598-022-20335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
The evidence for the impact of benzodiazepine (BZD) use on infection or clinical outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited. We evaluated the association of BZD use with SARS-CoV-2 infection and the clinical outcomes of coronavirus disease 2019 (COVID-19) using a nationwide COVID-19 database from South Korea. This nationwide cohort study was performed using the COVID-19 database from the Health Insurance Review and Assessment Service of Korea, and SARS-CoV-2 positivity was investigated according to BZD use. SARS-CoV-2-positive adult patients were assessed in three groups, those who needed hospitalization, those with severe symptoms requiring intensive care, and those who died. A multivariate logistic regression model was used for all the analyses. After adjusting for potential confounding factors, there was no association between BZD use and SARS-CoV-2 positivity. SARS-CoV-2-positive patients with BZD use showed an increased risk of need for hospitalization from COVID-19 compared to those without BZD use (odds ratio [OR]: 1.33, 95% confidence interval [CI] 1.07–1.65). In addition, there was a higher risk for long-term users (OR: 2.64, 95% CI 1.08–6.47). Chronic BZD use contributed to a higher risk of the need for hospitalization among COVID-19 patients, whereas BZD use did not increase the risk of SARS-CoV-2 test positivity, severe outcomes, or mortality.
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Kuo CL, Chien IC, Lin CH. Trends, correlates, and disease patterns of sedative-hypnotic use among elderly persons in Taiwan. BMC Psychiatry 2022; 22:316. [PMID: 35508990 PMCID: PMC9066755 DOI: 10.1186/s12888-022-03964-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The population-based National Health Insurance database was adopted to investigate the prevalence, correlates, and disease patterns of sedative-hypnotic use in elderly persons in Taiwan. METHODS The National Health Research Institutes provided a database of 1,000,000 random subjects in the National Health Insurance program. We adopted this sample of subjects who were older than 65 years from 1997 to 2005 and examined the proportions of psychiatric and nonpsychiatric disorders with regard to sedative-hypnotic use. RESULTS The 1-year prevalence of sedative-hypnotic use in elderly individuals increased from 1.7% in 1997 to 5.5% in 2005. The 1-year prevalence rates of benzodiazepine (BZD) and non-BZD hypnotics were 3.2 and 3.1%, respectively, in 2005. The overall hypnotic use was highest in ≥85-year-olds, males, those with lower amounts of insurance or higher Charlson Comorbidity Index scores and those living in eastern Taiwan. Both BZD and non-BZD hypnotic use were most commonly used in nonpsychiatric disorders instead of psychiatric disorders. Among the psychiatric disorders, the disorders that accounted for higher BZD and non-BZD hypnotic use were senile and presenile organic psychotic conditions (3.4 and 3.4%, respectively). Higher BZD and non-BZD use was for diseases of the respiratory system (30.4 and 17.8%, respectively), the circulatory system (20.4 and 22.4%, respectively), and neoplasms (12.6 and 13.8%, respectively). CONCLUSION The prevalence rates of both BZD and non-BZD sedative-hypnotic use increased from 1997 to 2005 in the elderly. The risk factors for sedative-hypnotic use were aging, male sex, lower insurance amount, and higher Charlson Comorbidity Index scores. Most BZD and non-BZD sedative-hypnotic users were persons with nonpsychiatric disorders.
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Affiliation(s)
- Chia-Lun Kuo
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan ,grid.64523.360000 0004 0532 3255Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Chia Chien
- Bali Psychiatric Center, Ministry of Health and Welfare, No. 33, HuaFuShan Rd, Bali District, New Taipei City, 249, Taiwan. .,National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Heng Lin
- grid.410764.00000 0004 0573 0731Taichung Veterans General Hospital, Taichung, Taiwan ,grid.412146.40000 0004 0573 0416National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Vozoris NT. A critical review of the respiratory benefits and harms of orally administered opioids for dyspnea management in COPD. Expert Rev Respir Med 2021; 15:1579-1587. [PMID: 34761704 DOI: 10.1080/17476348.2021.2005584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Dyspnea occurring in chronic obstructive pulmonary disease (COPD) that is refractory to traditional management strategies is a common and challenging problem. Considerable attention has been paid to the off-label use of orally administered opioids as a pharmacotherapy option for refractory dyspnea in COPD. Multiple professional respiratory society guidelines express support for the application of oral opioids for this purpose. AREAS COVERED This manuscript will critically review randomized controlled trials undertaken to date that evaluate the efficacy of oral opioids for dyspnea in COPD, as well as phase IV observational studies that examine for potential opioid-related respiratory harms in the COPD population (literature was searched on PubMed up to June 2021). COPD guideline recommendations relating to opioids for dyspnea will subsequently be critiqued. EXPERT OPINION Opioid efficacy trials demonstrate at best a small improvement in dyspnea in limited numbers of individuals with COPD, whereas safety trials consistently show an increased risk of respiratory-related exacerbation, hospitalization and death in association with opioid use. In contrast to what is expressed in guidelines, the current body of evidence does not the support the wide application of opioids to manage refractory dyspnea among individuals with COPD, but instead, a highly selective and careful approach.
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Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Chronic Disease and Pharmacotherapy Program, ICES (Formerly Known as Institute for Clinical Evaluative Sciences), Toronto, Canada
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Gershon AS, Pequeno P, Machado AA, Aaron SD, Kendzerska T, Luo J, Stanbrook MB, Tan WC, Porter J, To T. FACTORS ASSOCIATED WITH NON-RECEIPT OF RECOMMENDED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MEDICATIONS: A POPULATION STUDY. Chest 2021; 160:1670-1680. [PMID: 34144022 DOI: 10.1016/j.chest.2021.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practise guidelines. RESEARCH QUESTION How common is non-receipt of recommended medications among people with COPD and what are factors associated with non-receipt? STUDY DESIGN AND METHODS We conducted a population cohort study in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged 65 and older. Health administrative data were used to identify people 66 years of age or older with physician-diagnosed COPD as of 2018 and group them into lower or higher risk for future COPD exacerbation groups. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modelling was used to determine associations between patient and physician factors and non-receipt of recommended medications. RESULTS About 54% and 88% of people with COPD receoved sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with non-receipt of recommended medications in both groups. People who had a co-diagnosis of asthma and who received care by a pulmonologist and spirometry were more likely to receive recommended medication . INTERPRETATION COPD medications appear underused by the COPD population and various factors are associated with sub-optimal receipt. Targeting these factors would help improve the care and health of people with COPD.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Shawn D Aaron
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Tetyana Kendzerska
- ICES, Toronto and Ottawa, ON, Canada; The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Jin Luo
- ICES, Toronto and Ottawa, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, ON, Canada
| | - Wan C Tan
- University of British Columbia, UBC James Hogg Research Laboratories, Providence Heart and Lung Institute, Vancouver, BC, Canada
| | | | - Teresa To
- ICES, Toronto and Ottawa, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Peiffer G, Underner M, Perriot J, Fond G. [COPD, anxiety-depression and cognitive disorders: Does inflammation play a major role?]. Rev Mal Respir 2021; 38:357-371. [PMID: 33820658 DOI: 10.1016/j.rmr.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
COPD is a chronic respiratory disease, often associated with extrapulmonary manifestations. Co-morbidities, including anxiety, depression and cognitive impairment, worsen its progression and quality of life. The prevalence of these disorders is high, yet they are often poorly understood and inadequately managed. In the development of psychological disorders, there is accumulated evidence highlighting the major role of systemic inflammation, as well as chronic disease, genetics, the consequences of smoking, hypoxaemia, oxidative stress, and the gut microbiome In addition to traditional treatments such as bronchodilatator medications, respiratory rehabilitation and smoking cessation, systemic inflammation is an interesting therapeutic target, with the use of anti-inflammatory drugs, anti-cytokines, and nutritional interventions.
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Affiliation(s)
- G Peiffer
- Service de pneumologie - tabacologie, CHR Metz-Thionville, 57085 Metz cedex 3, France.
| | - M Underner
- Unité de recherche clinique, université de Poitiers, centre hospitalier Henri-Laborit, 86021 Poitiers, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Fond
- CEReSS, hôpital de la Conception, Marseille Université, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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Pelgrim CE, van den Heuvel JM, Folkerts G, Garssen J, Maitland-van der Zee AH, Kraneveld AD. Higher prescription of antidepressants and/or anxiolytics among chronic obstructive pulmonary disease patients. Ther Adv Respir Dis 2021; 15:1753466620961696. [PMID: 33752539 PMCID: PMC8093612 DOI: 10.1177/1753466620961696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by
psychiatric problems, such as depression and anxiety, affecting both
treatment outcomes and mortality. Evidence for the number of COPD patients
using medication for these disorders is sparse. In this study, chronic
antidepressant (ATD) and anxiolytic (ANX) drug use – to identify depression
and anxiety – among COPD patients was compared with subjects with or without
other chronic diseases. Methods: The NControl database containing prescription data of 800 pharmacies
including 7 million individuals in The Netherlands was used. Patients of age
55+ years who received frequent prescriptions – at least two/year in 5 out
of 6 years – for COPD medication, dermatological drugs, disease-modifying
antirheumatic drugs (DMARDs), statins and oral glucose-lowering medication
were analyzed for concomitant chronic use of ATDs and ANXs between 1 January
2013 and 1 January 2019. All other subjects aged 55+ years were included as
a control group (control group 1). This group was further stratified into a
group of subjects that received frequent prescriptions of any kind (control
group 2). Results: 15.2% of the patients that receive COPD treatment
(n = 96,319), 15.3% of subjects that are treated for
dermatological problems (n = 62,865), 13.2% of subjects
that receive DMARDs (n = 7900), 11.6% of statins users
(n = 422,376) and 11.4% of oral glucose-lowering
medication users (n = 165,975) are also chronically treated
for depression or anxiety, compared with 2.6% (control group 1;
n = 3,290,608) and 11.4% (control group 2;
n = 757,947). In general, female and 75+ years aged
subjects showed a higher risk for using ATDs and ANXs chronically. In the
COPD and the dermatological patient group the risk was the highest compared
with the other patient groups. Conclusions: The rates of chronic ATD and ANX use and the risk of having depression and/or
anxiety are especially high in COPD patients, indicating that psychiatric
problems are more common in COPD than in most other chronic diseases. In
general, age and gender strongly influence the risk of chronically using
ATDs and ANXs. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Jan Maurik van den Heuvel
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands Danone Nutricia Research, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, 3508 TC, The Netherlands
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Li SQ, Sun XW, Zhang L, Ding YJ, Li HP, Yan YR, Lin YN, Zhou JP, Li QY. Impact of insomnia and obstructive sleep apnea on the risk of acute exacerbation of chronic obstructive pulmonary disease. Sleep Med Rev 2021; 58:101444. [PMID: 33601330 DOI: 10.1016/j.smrv.2021.101444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health burden worldwide. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is characterized by worsening of patients' respiratory symptoms that requires a modification in medication. This event could accelerate disease progression and increase the risk of hospital admissions and mortality. Both insomnia and obstructive sleep apnea (OSA) are prevalent in patients with COPD, and are linked to increased susceptibility to AECOPD. Improper treatment of insomnia may increase the risk of adverse respiratory outcomes for patients with COPD, while effective continuous positive airway pressure (CPAP) treatment may reduce the risk of AECOPD and mortality in patients with overlap syndrome. Sleep disorders should be considered in clinical management for COPD.
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Affiliation(s)
- Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xian Wen Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yong Jie Ding
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jian Ping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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14
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Gamboa D, Jørgenrud B, Bryun EA, Vindenes V, Koshkina EA, Nadezhdin AV, Kabashi S, Tetenova EJ, Berg T, Nyman AAT, Kolgashkin AJ, Petukhov AE, Perekhodov SN, Davydova EN, Lerdal A, Nordby G, Bogstrand ST. Prevalence of psychoactive substance use among acutely hospitalised patients in Oslo and Moscow: a cross-sectional, observational study. BMJ Open 2020; 10:e032572. [PMID: 32948540 PMCID: PMC7500296 DOI: 10.1136/bmjopen-2019-032572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The use of psychoactive prescription medication is increasing in the general population. This is a cause for concern, particularly among the elderly, where physiological changes related to senescence increase the risk for adverse effects. While previous studies regarding psychoactive substance use have generally been population based, we sought to determine the frequency of such use among acutely hospitalised patients. SETTING Two emergency departments (EDs), one in Oslo and one in Moscow, admitting patients to Departments of Internal Medicine. PARTICIPANTS 5583 patients aged ≥18 years participated, distributed evenly between genders and study locations. Patients unable to give informed consent were excluded. The study sites did not admit patients with surgical conditions and/or injuries. PRIMARY AND SECONDARY OUTCOMES The presence of psychoactive substances was determined through blood analysis using liquid chromatography-mass spectrometry. Secondary outcomes comprised demographic data (including age, gender, employment and marital status), degree of psychological distress, concurrent alcohol use, and self-reported alcohol, psychoactive drug and illicit substance use. RESULTS 32.3% in Oslo and 12% in Moscow were positive for one or more psychoactive medicinal drugs (benzodiazepines, z-hypnotics, opioids or barbiturates). In Oslo, medicinal drug use was associated with being aged 61 to 70 years (OR 2.40, 95% CI 1.61 to 3.58) compared with 18 to 40 years, and psychological distress (OR 2.61, 95% CI 2.06 to 3.30). In Moscow, psychoactive medicinal drug use was also associated with psychological distress (OR 1.68, 95% CI 1.18 to 2.39), and was less common among patients aged 41 to 60 years (OR 0.62, 95% CI 0.43 to 0.88) than among patients aged 18 to 40 years. CONCLUSION A significant proportion of admitted patients used one or more psychoactive medicinal drugs, in particular benzodiazepines (Oslo and Moscow) and opiates (Oslo). We suggest formalised screening for inappropriate prescription drug use and increased adherence to clinical prescription guidelines.
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Affiliation(s)
- Danil Gamboa
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Evgeny A Bryun
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Vigdis Vindenes
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Evgenya A Koshkina
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
| | - Aleksei V Nadezhdin
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Saranda Kabashi
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elena J Tetenova
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
| | - Thomas Berg
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Alexey J Kolgashkin
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
| | - Aleksei E Petukhov
- Moscow Research and Practical Centre on Addictions, Moscow Department of Health, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Gudmund Nordby
- Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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15
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Bove DG, Lavesen M, Lindegaard B. Characteristics and health related quality of life in a population with advanced chronic obstructive pulmonary disease, a cross-sectional study. BMC Palliat Care 2020; 19:84. [PMID: 32552723 PMCID: PMC7301437 DOI: 10.1186/s12904-020-00593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/15/2020] [Indexed: 04/09/2023] Open
Abstract
Background It is important to understand the total burden of COPD and thereby be able to identify patients who need more intensive palliative care to avoid deteriorated quality of life. The aim of this study was to describe the psychosocial and demographic characteristics of a population with advanced COPD in a stable phase of the disease. Methods This study was cross-sectional based on a prospective observational cohort. The following questionnaires were administered: Chronic Respiratory Disease Questionnaire (CRQ), The COPD Assessment Test (CAT), The Hospital and Anxiety and Depression Scale (HADS), The Medical Research Council dyspnoea scale (MRC), and self-rate general health. Results We included 242 patients with advanced COPD from a Danish pulmonary outpatient clinic. Their mean FEV1 was 38% (±12.7) and 19% were treated with long term oxygen. The mean CRQ domain score was CRQ-dyspnea 4.21 (±1.4), CRQ-Mastery 4.88 (±1.3), CRQ-Emotional 4.81 (±1.2), CRQ-Fatigue 3.93 (±1.3). The mean CAT-score was 18.4 (± 6.7), and 44% had a CAT score > 20. The mean score on the subscale for anxiety (HADS-A) and depression (HADS-D) was 5.07 (±3.9) and 5.77 (±3.9), respectively. Thirty percent self-rated their health as bad or very bad and 19.8% were current smokers. Conclusions This study describes the characteristics of a population with advanced COPD in a stable phase of their disease. Our results illustrate how the population although treated in an outpatient structure already focusing on palliative needs, still live with unmet palliative needs and impaired quality of life.
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Affiliation(s)
- D G Bove
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark. .,Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - M Lavesen
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark.,Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - B Lindegaard
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
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16
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Zheng D, Brett J, Daniels B, Buckley NA, Pearson SA, Schaffer AL. Potentially inappropriate benzodiazepine use in Australian adults: A population-based study (2014-2017). Drug Alcohol Rev 2020; 39:575-582. [PMID: 32391624 DOI: 10.1111/dar.13086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/17/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Inappropriate benzodiazepine use continues to cause substantial morbidity and mortality globally. We aimed to characterise the initiation of new benzodiazepine treatment episodes in Australia and identify correlates of potentially inappropriate benzodiazepine use. DESIGN AND METHODS We conducted a population-based cohort study using dispensing claims from a 10% sample of Pharmaceutical Benefit Scheme eligible Australians (2014-2017). Our cohort comprised adults initiating a new benzodiazepine treatment; we defined potentially inappropriate use as ≥3 benzodiazepine dispensing over any continuous 90-day period in the year following initiation. We examined characteristics associated with potentially inappropriate benzodiazepine use using multivariable logistic regression. RESULTS People initiating a new benzodiazepine treatment episode (n = 276 765) were more frequently female (59.1%) and <65 years of age (73.6%). In the 90 days prior to initiating benzodiazepine, people were commonly dispensed antidepressants (26.5%), opioid analgesics (17.6%) and antipsychotics (4.7%). In the first year after initiation, 20 938 (9.5%) people experienced 'potentially inappropriate use'. Having a greater initial quantity of benzodiazepine dispensed [odds ratio (OR), 1.10; 95% confidence interval (CI) 1.08-1.12 per 10 defined daily doses increase], dispensing of antipsychotics (OR 3.00, 95% CI 2.86-3.15) and >5 unique medicines (OR 2.54, 95% CI 2.44-2.64; vs. ≤5 unique medicines) in the 90 days prior to initiation were associated with potentially inappropriate benzodiazepine use. DISCUSSION AND CONCLUSIONS Approximately, 1 in 10 people who initiated benzodiazepines were using it beyond the guideline recommended period. We identified factors at the time of initiation associated with potentially inappropriate use; clinicians should consider these before prescribing benzodiazepines and initiate conversations about alternative therapy when necessary.
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Affiliation(s)
- Danni Zheng
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.,Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Brett
- Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,St Vincent's Hospital, Sydney and New South Wales Poisons Information Centre, Sydney, Australia
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.,Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
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17
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Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
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Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain.,CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
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18
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Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder. Ann Am Thorac Soc 2020; 16:82-90. [PMID: 30309243 DOI: 10.1513/annalsats.201802-145oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Benzodiazepines are associated with mortality and poor outcomes among patients with chronic obstructive pulmonary disease (COPD), but use of benzodiazepines for dyspnea among patients with end-stage disease may confound this relationship. OBJECTIVES Assess the mortality risks of long-term benzodiazepine exposure among patients with COPD and comorbid post-traumatic stress disorder (PTSD), patients with chronic nonrespiratory indications for benzodiazepines. METHODS We identified all patients with COPD and PTSD within the Veteran's Health Administration between 2010 and 2012. We calculated propensity scores for benzodiazepine use and compared overall and cause-specific mortality of patients with long-term (≥90 d) benzodiazepine use relative to matched patients without use. Secondary analyses assessed propensity-adjusted survival by characteristics of benzodiazepine exposure. RESULTS Among 44,555 eligible patients with COPD and PTSD, 23.6% received benzodiazepines long term. In the matched sample of 19,552 patients, we observed no mortality difference (hazard ratio [HR] for long-term use, 1.06; 95% confidence interval [CI], 0.95-1.18) but greater risk of death by suicide among those with long-term use (HR, 2.33; 95% CI, 1.14-4.79). Among matched and unmatched patients, short-term benzodiazepine use, but not long-term use, was associated with increased mortality (short-term: HR, 1.16; 95% CI, 1.05-1.28; long-term: HR, 1.03; 95% CI, 0.94-1.13). CONCLUSIONS 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. Suicide associated with benzodiazepine use in this population warrants further investigation.
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19
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Benzodiazepine Prescribing in People with Chronic Obstructive Pulmonary Disease: Clinical Considerations. Drugs Aging 2020; 37:263-270. [PMID: 32107742 DOI: 10.1007/s40266-020-00756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Benzodiazepines, available clinically for almost six decades, are still one of the most widely prescribed classes of medication. The proportion of the population prescribed benzodiazepines increases with age, and harms also increase with age. The prevalence of prescribing in people > 85 years of age is as high as one in three, including in people with chronic obstructive pulmonary disease (COPD). The prevalence of COPD also increases with age. In COPD, indications cited for prescribing a benzodiazepine include anxiety, sleep disorders, or chronic breathlessness. Each of these symptoms is prevalent in the population with COPD, especially later in the course of the illness. For anxiety and insomnia, there is evidence to support short-term use, with little robust evidence to support prescribing for the symptomatic reduction of chronic breathlessness. People prescribed benzodiazepines are more likely to experience drowsiness or somnolence, exacerbations of their COPD, and respiratory tract infections. Furthermore, the longer people take benzodiazepines, the more likely they will become dependent on them. Prescribing patterns vary internationally but prescriptions of longer-acting benzodiazepines are declining in favour of shorter-acting compounds. Other evidence-based therapies that can more safely treat these problematic symptoms are available. For people already taking benzodiazepines, there are a number of interventions that have been shown to reduce the rate of prescribing. For people with COPD and not taking a benzodiazepine, but with symptoms where there is evidence of benefit, clinicians should weigh carefully the potential net benefit and prescribe at the lowest dose for the briefest time possible.
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20
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Prescription Synthetic Oral Cannabinoid use Among Older Adults with Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. Drugs Aging 2020; 36:1035-1045. [PMID: 31552597 DOI: 10.1007/s40266-019-00707-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Synthetic oral cannabinoids (nabilone and dronabinol) may have adverse respiratory effects. Our purpose was to describe the scope, pattern, and patient characteristics associated with incident off-label synthetic oral cannabinoid use among older adults with chronic obstructive pulmonary disease (COPD) compared to older adults without COPD. METHODS This was a retrospective, population-based, cohort study using Ontario, Canada, heath administrative data. Individuals aged 66 years or older were included, and physician-diagnosed COPD was identified using a previously validated, highly specific algorithm. Incident off-label oral cannabinoid use was examined between April 1, 2005 and March 31, 2015. Descriptive statistics were used to describe drug use patterns. Multiple logistic regression was used to identify patient characteristics associated with incident drug use. RESULTS There were 172,282 older adults with COPD and 1,068,256 older adults without COPD identified between April 1, 2005 and March 31, 2015. Incident synthetic oral cannabinoid use during this period occurred with significantly greater (p < 0.001) frequency among older adults with COPD (0.6%) versus older adults without COPD (0.3%). Compared to those without COPD, older adults with COPD used synthetic cannabinoids for significantly longer durations and more frequently at higher doses. CONCLUSIONS Although incident off-label oral cannabinoid use was relatively low among all older Ontarian adults, this drug class was used with greater frequency and more often in potentially concerning ways among older adults with COPD. These findings raise possible safety concerns, but further research on the respiratory safety of oral cannabinoids among individuals with COPD is needed.
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21
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Quinn KL, Campitelli MA, Diong C, Daneman N, Stall NM, Morris AM, Detsky AS, Jeffs L, Maxwell CJ, Bell CM, Bronskill SE. Association between Physician Intensity of Antibiotic Prescribing and the Prescription of Benzodiazepines, Opioids and Proton-Pump Inhibitors to Nursing Home Residents: a Population-Based Observational Study. J Gen Intern Med 2019; 34:2763-2771. [PMID: 31576508 PMCID: PMC6854144 DOI: 10.1007/s11606-019-05333-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/11/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician's overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician's current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown. OBJECTIVE To examine the association between a physician's rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults. DESIGN Population-based cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients. PARTICIPANTS 1926 physicians who provided care among 128,979 physician-patient pairs in 2015. MAIN MEASURES Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics. KEY RESULTS Compared with average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11-1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17-1.39]) or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27-1.51]]. High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90-13.39]) and also more likely to initiate all three medications, compared with average-intensity prescribers. CONCLUSIONS The intensity of a physician's episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors, instead of prescribing behaviors for single medications.
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Affiliation(s)
- Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Department of Medicine, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada.
| | | | | | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nathan M Stall
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew M Morris
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Allan S Detsky
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Colleen J Maxwell
- ICES, Toronto, ON, Canada.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sinai Health System, Toronto, Ontario, M5G 1X5, Canada
| | - Susan E Bronskill
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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22
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Does Sleep Apnea Worsen the Adverse Effects of Opioids and Benzodiazepines on Chronic Obstructive Pulmonary Disease? Ann Am Thorac Soc 2019; 16:1237-1238. [PMID: 31573347 DOI: 10.1513/annalsats.201907-504ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Baillargeon J, Singh G, Kuo YF, Raji MA, Westra J, Sharma G. Association of Opioid and Benzodiazepine Use with Adverse Respiratory Events in Older Adults with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2019; 16:1245-1251. [PMID: 31104504 PMCID: PMC6812171 DOI: 10.1513/annalsats.201901-024oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health
- Sealy Center on Aging, and
| | - Gurinder Singh
- Internal Medicine Residency Program, San Joaquin General Hospital, French Camp, California
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health
- Sealy Center on Aging, and
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; and
| | - Mukaila A. Raji
- Sealy Center on Aging, and
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; and
| | - Jordan Westra
- Department of Preventive Medicine and Community Health
| | - Gulshan Sharma
- Sealy Center on Aging, and
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; and
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24
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Vozoris NT. Benzodiazepine and opioid co-usage in the US population, 1999–2014: an exploratory analysis. Sleep 2019; 42:5283516. [DOI: 10.1093/sleep/zsy264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/03/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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25
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Pelgrim CE, Peterson JD, Gosker HR, Schols AMWJ, van Helvoort A, Garssen J, Folkerts G, Kraneveld AD. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both? Eur J Pharmacol 2018; 842:99-110. [PMID: 30336140 DOI: 10.1016/j.ejphar.2018.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022]
Abstract
COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation. Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.
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Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Julia D Peterson
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Ardy van Helvoort
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands; Nutrition, Metabolism and Muscle Sciences, Nutricia Research, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Platform Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Veterinary Pharmacology & Therapeutics, Institute of Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
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26
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Motter FR, Fritzen JS, Hilmer SN, Paniz ÉV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol 2018; 74:679-700. [PMID: 29589066 DOI: 10.1007/s00228-018-2446-0] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Potentially inappropriate medication (PIM) use causes preventable adverse drug reactions in older patients. Several assessment tools have been published to identify and avoid PIM use. In this systematic literature review, we aim to provide summaries and comparisons of validated PIMs lists published between 1991 and 2017 internationally. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), we performed a systematic review of articles describing the development and validation of criteria for identification of PIMs among older people published between January 1991 and April 2017. The searches were conducted on PUBMED, AgeLine, Academic Search, Academic Search Premier, and CINAHL. We identified the most common medications/classes described as PIM. We also identified the drug-disease interactions and drug-drug interactions reported among criteria. RESULTS From 2933 articles screened, 36 met our inclusion criteria. The majority used the Delphi method to validate their criteria. We identified 907 different medications/classes, 536 different drug disease interactions involving 84 diseases/conditions, and 159 drug-drug interactions. Benzodiazepines and nonsteroidal anti-inflammatory drugs were the medications most commonly reported as potentially inappropriate for older people. CONCLUSION Although approaches aimed at detecting inappropriate prescribing have intensified in recent years, we observed limited overlap between different PIM lists. Additionally, some PIM lists did not provide special considerations of use and alternative therapies to avoid PIMs. These facts may compromise the use of PIM lists in clinical practice. Future PIM lists should integrate information about alternative therapies and special considerations of use in order to help clinicians in the drug prescription.
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Affiliation(s)
- Fabiane Raquel Motter
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil. .,Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
| | - Janaína Soder Fritzen
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil
| | - Sarah Nicole Hilmer
- Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Érika Vieira Paniz
- Faculty of Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400,4º andar Faculdade de Medicin, Porto Alegre, RS, 90035-003, Brazil
| | - Vera Maria Vieira Paniz
- Postgraduate Program in Collective Health, University of Vale do Rio dos Sinos (UNISINOS), Av. Unisinos, 920, Sao Leopoldo, RS, 93022-000, Brazil
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27
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A Review of Adverse Outcomes Associated with Psychoactive Drug Use in Nursing Home Residents with Dementia. Drugs Aging 2016; 33:865-888. [DOI: 10.1007/s40266-016-0414-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Simon ST, Higginson IJ, Booth S, Harding R, Weingärtner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 2016; 10:CD007354. [PMID: 27764523 PMCID: PMC6464146 DOI: 10.1002/14651858.cd007354.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 1, 2010, on 'Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults'. Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. At the time of the previously published Cochrane review, there was no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in people with advanced cancer and chronic obstructive pulmonary disease (COPD). OBJECTIVES The primary objective of this review was to determine the efficacy of benzodiazepines for the relief of breathlessness in people with advanced disease. Secondary objectives were to determine the efficacy of different benzodiazepines, different doses of benzodiazepines, different routes of application, adverse effects of benzodiazepines, and the efficacy in different disease groups. SEARCH METHODS This is an update of a review published in 2010. We searched 14 electronic databases up to September 2009 for the original review. We checked the reference lists of all relevant studies, key textbooks, reviews, and websites. For the update, we searched CENTRAL, MEDLINE, and EMBASE and registers of clinical trials for further ongoing or unpublished studies, up to August 2016. We contacted study investigators and experts in the field of palliative care asking for further studies, unpublished data, or study details when necessary. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effect of benzodiazepines compared with placebo or active control in relieving breathlessness in people with advanced stages of cancer, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), motor neurone disease (MND), and idiopathic pulmonary fibrosis (IPF). DATA COLLECTION AND ANALYSIS Two review authors independently assessed identified titles and abstracts. Three review authors independently performed assessment of all potentially relevant studies (full text), data extraction, and assessment of methodological quality. We carried out meta-analysis where appropriate. MAIN RESULTS Overall, we identified eight studies for inclusion: seven in the previous review and an additional study for this update. We also identified two studies awaiting classification in this update. The studies were small (a maximum number of 101 participants) and comprised data from a total of 214 participants with advanced cancer or COPD, which we analysed. There was only one study of low risk of bias. Most of the studies had an unclear risk of bias due to lack of information on random sequence generation, concealment, and attrition. Analysis of all studies did not show a beneficial effect of benzodiazepines for the relief of breathlessness (the primary outcome) in people with advanced cancer and COPD (8 studies, 214 participants) compared to placebo, midazolam, morphine, or promethazine. Furthermore, we observed no statistically significant effect in the prevention of episodic breathlessness (breakthrough dyspnoea) in people with cancer (after 48 hours: risk ratio of 0.76 (95% CI 0.53 to 1.09; 2 studies, 108 participants)) compared to morphine. Sensitivity analyses demonstrated no statistically significant differences regarding type of benzodiazepine, dose, route and frequency of delivery, duration of treatment, or type of control. Benzodiazepines caused statistically significantly more adverse events, particularly drowsiness and somnolence, when compared to placebo (risk difference 0.74 (95% CI 0.37, 1.11); 3 studies, 38 participants). In contrast, two studies reported that morphine caused more adverse events than midazolam (RD -0.18 (95% CI -0.31, -0.04); 194 participants). AUTHORS' CONCLUSIONS Since the last version of this review, we have identified one new study for inclusion, but the conclusions remain unchanged. There is no evidence for or against benzodiazepines for the relief of breathlessness in people with advanced cancer and COPD. Benzodiazepines caused more drowsiness as an adverse effect compared to placebo, but less compared to morphine. Benzodiazepines may be considered as a second- or third-line treatment, when opioids and non-pharmacological measures have failed to control breathlessness. There is a need for well-conducted and adequately powered studies.
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Affiliation(s)
- Steffen T Simon
- Institute of Palliative Care (ipac)Jägerstr. 64‐66OldenburgGermany26121
- University Hospital of CologneDepartment of Palliative MedicineCologneGermany
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Irene J Higginson
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Sara Booth
- Cambridge University HospitalsDepartment of Palliative CareCambridgeUK
| | - Richard Harding
- King's College LondonDepartment of Palliative Care, Policy and Rehabilitation, Cicely Saunders InstituteLondonUK
| | - Vera Weingärtner
- University Hospital of CologneDepartment of Palliative MedicineCologneGermany
| | - Claudia Bausewein
- LMU MunichDepartment of Palliative Medicine, Munich University HospitalMarchioninistr. 15MunichGermany81377
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Vukoja M, Kopitovic I, Milicic D, Maksimovic O, Pavlovic-Popovic Z, Ilic M. Sleep quality and daytime sleepiness in patients with COPD and asthma. CLINICAL RESPIRATORY JOURNAL 2016; 12:398-403. [PMID: 27402309 DOI: 10.1111/crj.12528] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nocturnal symptoms are common and important in both asthma and COPD but the relationship between sleep quality and diseases' characteristics has not been fully studied. OBJECTIVE To compare sleep quality and daytime sleepiness in asthma and COPD patients and to explore its relation to diseases' characteristics. METHODS In this cross-sectional study, we examined 217 consecutive asthma and COPD patients who underwent pulmonary function tests at The Center for Pathophysiology of Breathing and Sleep Medicine of The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia between July 2014 and January 2015. All patients completed Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). RESULTS Study included 117 patients with asthma, 100 patients with COPD, and 102 healthy controls. There was no difference in PSQI and ESS between patients with asthma and COPD (4.9 ± 3.9 vs 5.8 ± 4.3, P = .09 and 4.8 ± 3.4 vs 4.7 ± 3.6, P = .69, respectively). PSQI and ESS did not correlate with lung function parameters. Patients with uncontrolled asthma had higher PSQI scores (uncontrolled 7.0 ± 3.7 vs partially controlled 4.6 ± 3.1 vs controlled 3.2 ± 3.7, P < .001). PSQI scores were higher in COPD group D and B compared to A and C (group D 6.9 ±4.6 vs B 6.8 ± 4.1 vs A 2.9 ± 1.3 vs C 3.1 ± 3.9, P < .001). Compared to asthma, COPD patients had longer sleep latency and used sleep regulating medications more often. CONCLUSIONS There is no difference in sleep quality and level of daytime sleepiness between patients with asthma and COPD. Poor sleep quality is related to level of asthma control and is associated with COPD groups B and D.
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Affiliation(s)
- Marija Vukoja
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Kopitovic
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Milicic
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Olivera Maksimovic
- Department for Chronic Obstructive Pulmonary Disease, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zora Pavlovic-Popovic
- Department for Sarcoidosis and Diffuse Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Miroslav Ilic
- Polyclinic, The Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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30
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Murphy Y, Wilson E, Goldner EM, Fischer B. Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995. Clin Drug Investig 2016; 36:519-30. [DOI: 10.1007/s40261-016-0397-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lu XM, Zhu JP, Zhou XM. The effect of benzodiazepines on insomnia in patients with chronic obstructive pulmonary disease: a meta-analysis of treatment efficacy and safety. Int J Chron Obstruct Pulmon Dis 2016; 11:675-85. [PMID: 27110106 PMCID: PMC4831601 DOI: 10.2147/copd.s98082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Insomnia is a common comorbidity associated with COPD. Although benzodiazepines (BZDs) can have adverse effects on respiratory response in COPD patients, these are the most common hypnotics. The aim of this study was to examine by meta-analysis the efficacy and safety of BZD to treat insomnia in COPD patients. Materials and methods Electronic databases (PubMed, China National Knowledge Infrastructure, Cochrane clinical trials database) were searched. Studies were eligible if they compared the effects of BZD versus placebo on insomnia in COPD patients. Two reviewers extracted data independently. Disagreements were resolved by discussion with another reviewer until a consensus was achieved. Data that included objective and subjective sleep evaluation and respiratory function variables were extracted. Data were analyzed by the methods recommended by Review Manager 5.3 software. Results A total of 233 records were identified through the initial search; of these, five studies were included in the meta-analysis. When BZD was compared with placebo, objective sleep quality was significantly improved, including total sleep time (95% confidence interval [CI] 0.54–1.14, P<0.00001), sleep efficiency (95% CI 0.48–1.16, P<0.00001), sleep latency (95% CI −18.24 to −4.46, P=0.001), and number of arousals/hour of sleep (95% CI −0.72 to −0.07, P=0.02). Otherwise, subjective sleep quality was not improved remarkably. Apart from maximum transcutaneous carbon dioxide pressure increase during sleep (95% CI 0.05–0.28, P=0.006), BZD administration had no effect on respiratory assessment. Conclusion In this meta-analysis, the results suggested BZDs might be efficient and safe hypnotics. Compared with placebo, BZD improved sleep quality partly, and significantly increased maximum transcutaneous carbon dioxide pressure during sleep. More randomized controlled trials are necessary to determine the potential effect of BZD in COPD patients with insomnia.
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Affiliation(s)
- Xiao-Min Lu
- Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, People's Republic of China
| | - Ji-Ping Zhu
- Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, People's Republic of China
| | - Xian-Mei Zhou
- Department of Respiratory Medicine, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, People's Republic of China
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Bénard-Laribière A, Noize P, Pambrun E, Bazin F, Verdoux H, Tournier M, Bégaud B, Pariente A. Comorbidities and concurrent medications increasing the risk of adverse drug reactions: prevalence in French benzodiazepine users. Eur J Clin Pharmacol 2016; 72:869-76. [PMID: 27023467 DOI: 10.1007/s00228-016-2044-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/11/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To estimate benzodiazepine prevalence of use and to quantify, in benzodiazepine users, the prevalence of comorbidities and concurrent medications increasing the risk of adverse drug reactions (ADRs). METHODS Cross-sectional study performed using data from the French national healthcare insurance system. The prevalence of use was estimated by considering as users, patients who had at least one benzodiazepine reimbursement during the year 2013. Patients at increased risk for benzodiazepine ADRs were those who had (i) drug-drug interactions at risk for central nervous system and respiratory depression and (ii) comorbidities at risk for adverse respiratory effects, or for falls or fractures. RESULTS Overall, the prevalence of benzodiazepine use in 2013 was estimated to be 13.8 %; it was higher among women and increased with age. This prevalence was 10.6 % for anxiolytic benzodiazepines, and 6.1 % for hypnotic benzodiazepines. Approximately half of the benzodiazepine users (48.1 %) were at increased risk for benzodiazepine ADRs; this proportion increased with age. Drug-drug interactions represented the most prevalent condition (39.3 % of benzodiazepine users). The drugs most frequently involved were opioids: analgesics (15.9 %) and antitussives (6.8 %). Overall, 11.3 % of benzodiazepine users had comorbidities at increased risk for adverse respiratory effects (13.9 % in those aged 65-79), and 7.0 % comorbidities at increased risk for falls or fractures (13.4 % in those aged ≥80). CONCLUSIONS This study found that benzodiazepine use remained high in France, and that roughly half of the users presented with comorbidities and concurrent medications increasing the risk of ADRs. These findings are of concern, given that benzodiazepines are frequently used, and especially among the elderly.
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Affiliation(s)
- Anne Bénard-Laribière
- University of Bordeaux, U1219, F-33000, Bordeaux, France.
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France.
| | - Pernelle Noize
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
- CIC Bordeaux CIC1401, F-33000, Bordeaux, France
| | - Elodie Pambrun
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
| | - Fabienne Bazin
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
| | - Hélène Verdoux
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
- Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
| | - Marie Tournier
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
- Centre Hospitalier Charles Perrens, F-33000, Bordeaux, France
| | - Bernard Bégaud
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Antoine Pariente
- University of Bordeaux, U1219, F-33000, Bordeaux, France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, F-33000, Bordeaux, France
- CHU Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
- CIC Bordeaux CIC1401, F-33000, Bordeaux, France
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Vozoris NT, Wang X, Fischer HD, Gershon AS, Bell CM, Gill SS, O'Donnell DE, Austin PC, Stephenson AL, Rochon PA. Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population-based cohort study. Br J Clin Pharmacol 2015; 81:161-70. [PMID: 26337922 DOI: 10.1111/bcp.12762] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/05/2015] [Accepted: 08/20/2015] [Indexed: 01/06/2023] Open
Abstract
AIMS The purpose of the present study was to describe the scope, pattern and patient characteristics associated with incident opioid use among older adults with chronic obstructive pulmonary disease (COPD). METHODS This was a retrospective population-based cohort study using Ontario, Canada, healthcare administrative data. Study participants were individuals aged 66 years and older with physician-diagnosed COPD, identified using a validated algorithm, who were not receiving palliative care. We examined the incidence of oral opioid receipt between 1 April 2003 and 31 March 2012, as well as several patterns of incident opioid drug use. RESULTS Among 107,109 community-dwelling and 16,207 long-term care resident older adults with COPD, 72,962 (68.1%) and 8811 (54.4%), respectively, received an incident opioid drug during the observation period. Among long-term care residents, multiple opioid dispensings (8.8%), dispensings for >30 days' duration (up to 19.8%), second dispensings (35-43%) and early refills (24.2%) were observed. Incident opioid dispensing was also observed to occur during COPD exacerbations (6.9% among all long-term care residents; 18.1% among long-term care residents with frequent exacerbations). These same patterns of incident opioid use occurred among community-dwelling individuals, but with relatively lower frequencies. CONCLUSIONS New opioid use was high among older adults with COPD. Potential safety concerns are raised by the degree and pattern of new opioid use, but further studies are needed to evaluate if adverse events are associated with opioid drug use in this older and respiratory-vulnerable population.
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Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hadas D Fischer
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Denis E O'Donnell
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Stephenson
- Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paula A Rochon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Halvorsen T, Martinussen PE. Benzodiazepine use in COPD: empirical evidence from Norway. Int J Chron Obstruct Pulmon Dis 2015; 10:1695-702. [PMID: 26356249 PMCID: PMC4559252 DOI: 10.2147/copd.s83107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The common comorbidities associated with COPD include, among others, anxiety, depression, and insomnia, for which the typical treatment involves the use of benzodiazepines (BZD). However, these medicines should be used with extra caution among COPD patients, since treatment with traditional BZD may compromise respiratory function. AIMS This study investigated the use of BZD among persons suffering from COPD by analyzing three relevant indicators: 1) the sum of defined daily doses (DDD); 2) the number of prescribers involved; and 3) the number of different types of BZD used. DATA AND METHODS The study builds on a linkage of national prescription data and patient-administrative data, which includes all Norwegian drug prescriptions to persons hospitalized with a COPD diagnosis during 2009, amounting to a total of 5,380 observations. Regression techniques were used to identify the patients and the clinical characteristics associated with BZD use. RESULTS Of the 5,380 COPD patients treated in hospital during 2009, 3,707 (69%) were dispensed BZD during the following 12 months. Moreover, they were dispensed on average 197.08 DDD, had 1.22 prescribers, and used 0.98 types of BZD during the year. Women are more likely to use BZD for all levels of BZD use. Overnight planned care not only increases the risk of BZD use (DDD), but also the number of prescribers and the types of BZD in use. CONCLUSION In light of the high levels of BZD prescription found in this study, especially among women, it is recommended that general practitioners, hospital specialists, and others treating COPD patients should aim to acquire a complete picture of their patients' BZD medication before more is prescribed in order to keep the use to a minimum.
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Affiliation(s)
- Thomas Halvorsen
- SINTEF Technology and Society, Department for Health Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål E Martinussen
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore) 2015; 94:e1110. [PMID: 26166105 PMCID: PMC4504567 DOI: 10.1097/md.0000000000001110] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD).We conducted a population-based case-control study to evaluate the effects of hypnotics on the risk of adverse respiratory events in patients with COPD.The case-control study was investigated using data retrieved from the Taiwan National Health Insurance Research Database. Patients with newly diagnosed adverse respiratory events (pneumonia, COPD with acute exacerbation, acute respiratory failure, and cardiopulmonary arrest) were included in the case group. Patients with COPD and no history of adverse respiratory events were randomly selected for the control group, which was frequency-matched with the case group according to index date, age (per 10 years), and sex. Patients who had used hypnotics within 1 month meant active users. The odds ratios (ORs) and 95% confidence intervals (CIs) of were calculated using univariable and multivariable logistic regression models.Most of the study participants were male (71.6%), and the mean ages of the participants in the case and control groups were 69.2 (±12.4) and 67.5 (±12.3) years, respectively. After potential confounding factors were adjusting for, the adjusted ORs of adverse respiratory events were 12.0 for active users of benzodiazepines (95% CI, 8.11-17.6) and 10.5 for active users of nonbenzodiazepines (95% CI, 7.68-14.2) compared with the adjusted ORs of those who never used hypnotics.The results of this epidemiological study suggested that hypnotics increased the risk of adverse respiratory events in patients with COPD.
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Affiliation(s)
- Wei-Sheng Chung
- From Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan (W-SC); Department of Health Services Administration, China Medical University, Taichung, Taiwan (W-SC); Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan (W-SC); Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan (C-YL); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (C-LL); College of Medicine, China Medical University, Taichung, Taiwan (C-LL); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Alonso T, García E, Segrelles G, Zamora E. Acidosis respiratoria secundaria a fármacos. Arch Bronconeumol 2015; 51:204-5. [DOI: 10.1016/j.arbres.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 11/16/2022]
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38
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DiSantostefano RL, Li H, Hinds D, Galkin DV, Rubin DB. Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis. Int J Chron Obstruct Pulmon Dis 2014; 9:457-68. [PMID: 24855350 PMCID: PMC4019612 DOI: 10.2147/copd.s60498] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pneumonia poses a significant risk in patients with moderate to severe chronic obstructive pulmonary disease but data are limited on the disease phenotypes most susceptible to pneumonia. Methods Cluster analysis using a data-driven recursive partitioning algorithm was employed using baseline data from two pooled one-year randomized exacerbation trials (n=3,255) of fluticasone furoate/vilanterol or vilanterol alone to identify distinct patient groups at greatest risk of pneumonia or serious (hospitalization or death) pneumonia. Results Five clusters were identified. Patients at greater risk of first pneumonia had more severe obstruction (forced expiratory volume in one second/forced vital capacity <46%) and either a body mass index <19 kg/m2 (hazard ratio 7.8, 95% confidence interval 4.7–13.0; n=144) or a pneumonia history and greater comorbidities (hazard ratio 4.8, 95% confidence interval 3.0–7.7; n=374) relative to the cluster with the lowest pneumonia risk (reference; n=1310). Multiple comorbidities and use of psychoanaleptics also contributed to an increased risk of pneumonia in more obstructed patients. Independent of cluster, use of inhaled corticosteroids was associated with pneumonia (hazard ratio 1.89, 95% confidence interval 1.25–2.84) and serious pneumonia (hazard ratio 2.92, 95% confidence interval 1.40–6.01). Conclusion Cluster analysis can identify patient populations at risk for serious safety outcomes and inform risk management strategies to optimize patient management. The greatest risk for pneumonia was in subjects with multiple pneumonia risk factors.
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Affiliation(s)
| | - Hao Li
- Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
| | - David Hinds
- Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
| | - Dmitry V Galkin
- Respiratory Clinical Development, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
| | - David B Rubin
- Respiratory Clinical Development, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
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Vozoris NT. Benzodiazepines and opioids need to be prescribed with caution in advanced COPD. EVIDENCE-BASED MEDICINE 2014; 19:170. [PMID: 24785470 DOI: 10.1136/eb-2014-101789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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