Other options usually better than benzodiazepines in alleviating dyspnoea, sleeping problems and anxiety in COPD patient
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Other options usually better than benzodiazepines in alleviating dyspnoea, sleeping problems and anxiety in COPD patients Caroline Fenton1 · Connie Kang1
© Springer Nature Switzerland AG 2020
Abstract Chronic obstructive pulmonary disease (COPD) is common, especially in older people, and causes progressive dyspnoea that is often accompanied by anxiety and depression. Benzodiazepines (BZDs) are regularly prescribed to COPD patients but can cause significant respiratory adverse events. There are usually better treatment alternatives, such as pulmonary rehabilitation and treatment with antidepressants. The increasing prescription of BZDs with age is concerning, particularly as COPD becomes more prevalent.
Benzodiazepines to ease COPD‑related complaints… Chronic obstructive pulmonary disease (COPD) is an underdiagnosed, preventable disease characterized by airflow limitation and persistent respiratory symptoms caused by lung and airway abnormalities [1]. Driven especially by tobacco smoking, but also by air pollution and the household use of biomass fuels, combined with aging populations [1], COPD is projected to be the third most common cause of death by the end of 2020 [1, 2]. Aside from premature mortality, COPD carries an enormous cost of morbidity, with distressing dyspnoea (breathlessness) and associated panic, anxiety and depression [1] having a major impact on people’s lives. Sleep disturbances, including sleep latency (problems falling asleep), early morning wakening and obstructive sleep apnoea (OSA) are also common [2]. Benzodiazepines (BZDs), available since the 1960s, are anxiolytics often prescribed to alleviate COPD symptoms, to the extent that one large US study suggests that 10% of COPD patients are now prescribed a BZD [3]. However, there is very little evidence to support this practice [1]. This article considers the effects of BZD prescription in COPD, and practical alternatives [2].
* Connie Kang [email protected] 1
Springer Nature, Private Bag 65901, Mairangi Bay, Auckland 0754, New Zealand
…is often questionable... Several trends, albeit with variations between countries, explain why the questionable combination of a COPD diagnosis and a BZD prescription is increasing [2, 4], despite some indication that such use is declining [4]. Both COPD and BZD use are more common in the elderly [1, 4]; the prevalence of COPD is highest in individuals aged > 60 years [1]. One in-depth Canadian study confirmed a direct correlation between age and BZD prescriptions, with ≈ 30% of individuals aged > 85 years receiving BZDs versus ≈ 20% of those aged 65–69 years [4]. Globally, women and men are now equally likely to have COPD [1], but women are significantly more likely to receive a BZD (relative risk 1.50; 95% CI 1.49–1.51), possibly reflecting their greater incidence of anxiety, insomnia and depression [4]. As the prevalence of COPD in women increases, so will the likelihood of a COPD plus BZD combination [1]. It is unclear why age is associated with increased BZD use; it possi
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