title: Incident opioid drug use and adverse respiratory outcomes among older adults with COPD.
abstract: We evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD).This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls.Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00-1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61-2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57-1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83-0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population.
authors.affiliation: Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, 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: Xuesong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
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, Department 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.
authors.forename: Denis E
authors.initials: DE
authors.lastname: O'Donnell
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: Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada Dept of Medicine, University of Toronto, Toronto, ON, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Dept of Medicine, Queen's University, Kingston, 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; D000369:Aged, 80 and over; D000465:Algorithms; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D009293:Opioid-Related Disorders / Q000150:complications*; D011014:Pneumonia / Q000150:complications / Q000401:mortality; D011336:Probability; D057216:Propensity Score; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D015272:Pulmonary Medicine; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D001993:Bronchodilator Agents