Safety of benzodiazepines and opioids in interstitial lung disease: A national prospective study

Sabrina Bajwah, Joanna Davies, Hanan Tanash, et al.
Eur Respir J 2018 (ePub ahead of print)
doi: 10.1183/13993003.01278-2018

Chronic breathlessness is a near-universal symptom of advanced fibrotic interstitial lung disease (ILD). Guidelines recommend the use of benzodiazepines (BZDs) and/or opioids for symptomatic management; however, recent studies have suggested a link between the use of these therapies and increased hospital admission or death in patients with chronic obstructive pulmonary disease (COPD). This study is the first to examine the association of BZDs and opioids with these adverse outcomes in patients with fibrotic ILD.

The study included 1603 patients, all starting long-term oxygen therapy (LTOT). BZDs were used by 196 (12%) patients, opioids by 252 (16%), and both by 59 (4%). There was no difference in baseline lung function between patients taking BZDs or opioids, compared with non-users.

Neither BZD nor opioid treatment had any significant association with hospitalisation rates. This was true even when looking at high- vs low-dose therapies. In general, opioids seemed to be associated with increased mortality, but this association disappeared when looking at adjusted risks for each dose level. BZD treatment was associated with increased mortality, in a dose-dependent fashion.

In summary, opioid treatment was not associated with increased risk of hospitalisation or death in advanced fibrotic ILD patients. High-dose BZD treatment was linked to increased mortality. However, the authors postulate that this could be confounded by the increased use of BZDs at the end of life, to relieve terminal anxiety-related breathlessness. Overall, the use of BZD and opioids in fibrotic ILD was lower, suggesting that this patient group may be currently undertreated and could benefit from holistic management of symptomatic breathlessness.