title: Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD.
abstract: Our purpose was to evaluate the association of new benzodiazepine use relative to non-use with adverse clinical respiratory outcomes among older adults with chronic obstructive pulmonary disease (COPD). This was a retrospective population-based cohort study of Ontario, Canada, residents between 2003 and 2010. A validated algorithm was applied to health administrative data to identify adults aged 66 years and older with COPD. Relative risks (RRs) of several clinically important respiratory outcomes were examined within 30 days of incident benzodiazepine use compared with non-use, applying propensity score matching. New benzodiazepine users were at significantly higher risk for outpatient respiratory exacerbations (RR 1.45, 95% CI 1.36-1.54) and emergency room visits for COPD or pneumonia (RR 1.92, 95% CI 1.69-2.18) compared to non-users. Risk of hospitalisation for COPD or pneumonia was also increased in benzodiazepine users, but was nonsignificant (RR 1.09, 95% CI 1.00-1.20). There were no significant differences in intensive care unit admissions between the two groups and all-cause mortality was slightly lower among new versus non-users. Benzodiazepines were associated with increased risk for several serious adverse respiratory outcomes among older adults with COPD. The findings suggest that decisions to use benzodiazepines in older patients with COPD need to consider potential adverse respiratory outcomes.
authors.affiliation: Division of Respirology, Dept of Medicine, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, ON, Canada Dept of Medicine, Queen's University, Kingston, ON, Canada nick.vozoris@utoronto.ca.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Vozoris
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Division of Respirology, Dept of Medicine, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, ON, Canada Dept of Medicine and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada 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.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada 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.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.affiliation: Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada Division of General Internal Medicine, Dept of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Dept of Medicine, Queen's University, Kingston, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada 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.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D003625:Data Collection; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology; D012120:Respiration Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001569:Benzodiazepines