Low Dose Opioids Tested in Patients with COPD

It is safe to use low dose opioids to treat breathlessness in patients with severe chronic obstructive pulmonary disease, according to a new study.

To evaluate the effects of treating patients with COPD using benzodiazepines and opioids on hospital admission rates and mortality, Swedish researchers followed 2249 patients beginning long-term oxygen therapy for COPD between 2005 and 2009. Of the 2249 participants, 24% used benzodiazepines, 23% used opioids, and 9% were using both drugs at baseline.
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During a median of 2.5 month follow-up, 1681 patients were admitted to the hospital and 1129 patients died.

Neither benzodiazepines nor opioids were associated with increased hospital admissions, but benzodiazepines were associated with increased mortality. Lower dose opioids were not associated with increases to mortality risk, nor did a combination of low dose opioids and low dose benzodiazepines. High dose opioids were associated with increased mortality rates.

“For clinicians, this study further supports the safety of regular low dose systemic opioids to reduce breathlessness in severely ill patients with respiratory compromise and hypercapnia—patients who have an immense need for relief of symptoms,” the researchers concluded.

–Michael Potts

Edstrom MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g445