Safety of benzodiazepines and opioids in lung disease

30th October 2018

Researchers have published results of the first ever study to examine associations between benzodiazepines, opioid use and harm in Interstitial Lung Disease (ILD). ILD is the 40th most frequent cause of death globally.  Mortality from ILD has increased by 52% in the last ten years.  Chronic breathlessness is experienced by all patients with ILD and is one of the most common burdensome and neglected symptoms.  Doctors struggle to manage this symptom in these patients.  It has a devastating impact on patients lives, limiting their well-being and quality of life and that of their family, friends and caregivers.  It is one of the most frequent causes of emergency hospital admission.

Data on the safety of BDZ and opioids in ILD are poor.  Concerns that these medication may cause adverse events, including respiratory depression, confusion, falls and even premature death are cited as barriers for respiratory and palliative care professionals.  So researchers set out to investigate the association of BDZ and opioids on the risk of admission to hospital and death in patients with ILD. This was a nationwide, population-based study using routine clinical data.  Researchers found that treatment with opioids was not associated with an increased risk of admission to hospital or death in these patients.  Treatment with BDZ was not clearly associated with the rate of hospital admission but was associated with increased mortality at higher doses.

Internationally no medication is licensed for chronic breathlessness, but emerging evidence in other disease groups supports regular low dose morphine as safe and efficacious.  The study showed that the use of BDZ and opioids in ILD was low, despite a recent ILD position statement stressing the importance of early and effective palliative care.  This research study provides new data on the safety of BDZ and opioids and may allay fears of clinicians who have been reluctant to prescribe these medications.  Improvements in breathlessness management may decrease patient admissions and deaths and improve the quality of life of ILD patients and carers.

Bajwah S, Davies JM, Tanash H, et al. Safety of benzodiazepines and opioids in interstitial lung disease: A national prospective study. Eur Respir J 2018; in press (