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Indications and patterns of use of benzodiazepines and opioids in severe interstitial lung disease: a population-based longitudinal study

Genberg, Jenny; Davies, Joanna M.; Ahmadi, Zainab; Currow, David; Johnson, Miriam J.; Tanash, Hanan; Bajwah, Sabrina; Ekström, Magnus

Authors

Jenny Genberg

Joanna M. Davies

Zainab Ahmadi

David Currow

Hanan Tanash

Sabrina Bajwah

Magnus Ekström



Abstract

Abstract
Background Despite evidence that opioids might relieve chronic breathlessness, physicians may still be reluctant to prescribe them due to safety concerns. By contrast, benzodiazepine (BDZ) prescribing often seeks to reduce chronic breathlessness despite no evidence of net benefit. Prescribing patterns and indications for these medications in severe interstitial lung disease (ILD) are unknown. Here, our objective was to evaluate the indications, medications and temporal patterns of BDZ and opioid prescriptions in people with oxygen-dependent ILD.

Methods This was an observational, population-based, longitudinal study of adults starting long-term oxygen therapy (LTOT) for ILD between 2005 and 2014 in the Swedish National Registry for Respiratory Failure (Swedevox). People dispensed BDZs (n=2000) and opioids (n=2000) from 6 months before start of LTOT throughout follow-up (first of death or study end) were analysed.

Results Of 1635 included patients, 651 (39.8%) received BDZs and 710 (43.4%) received opioids during the study period; 373 (22.8%) patients received both. The most frequently prescribed BDZs and opioids were oxazepam (85.6%) and oxycodone (28.7%), respectively. Indications for breathlessness were uncommon for BDZs (1.4%) and opioids (6.4%). During the last year of life, opioid indications for breathlessness increased from 2.5% (12–10 months before death) to 10.2% in the last 3 months of life (p=0.048).

Conclusions In oxygen-dependent ILD, opioids are rarely prescribed for breathlessness even in the last months of life, when chronic breathlessness often increases in prevalence and intensity.

Citation

Genberg, J., Davies, J. M., Ahmadi, Z., Currow, D., Johnson, M. J., Tanash, H., …Ekström, M. (2021). Indications and patterns of use of benzodiazepines and opioids in severe interstitial lung disease: a population-based longitudinal study. ERJ Open Research, 7(1), https://doi.org/10.1183/23120541.00716-2020

Journal Article Type Article
Acceptance Date Dec 4, 2020
Online Publication Date Feb 1, 2021
Publication Date 2021-01
Deposit Date Apr 30, 2021
Publicly Available Date May 4, 2021
Journal ERJ Open Research
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
Volume 7
Issue 1
Article Number 00716-2020
DOI https://doi.org/10.1183/23120541.00716-2020
Public URL https://hull-repository.worktribe.com/output/3761530

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