Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder
Lucas M Donovan ; Carol A Malte , Laura J Spece , Matthew F Griffith , Laura C Feemster ; Ruth A. Engelberg , David H Au , and Eric J Hawkins
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. Objective: Assess the mortality risks of long-term benzodiazepine exposure among patients with COPD and comorbid posttraumatic stress disorder (PTSD), patients with chronic non-respiratory indications for benzodiazepines. Methods: We identified all patients with COPD and PTSD within the Veteran’s Health Administration between 2010-12. We calculated propensity scores for benzodiazepine use, and compared overall and cause specific mortality of patients with long-term (≥90 days) 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 (HR for long-term use 1.06, 95%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.