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Chronic obstructive pulmonary disease
Respiratory events associated with concomitant opioid and sedative use among Medicare beneficiaries with chronic obstructive pulmonary disease
  1. Tham Thi Le1,2,
  2. Siyeon Park1,
  3. Michelle Choi3,
  4. Marniker Wijesinha4,
  5. Bilal Khokhar5 and
  6. Linda Simoni-Wastila1,2
  1. 1Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, Maryland, USA
  2. 2Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, Maryland, USA
  3. 3Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois, USA
  4. 4Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, Maryland, USA
  5. 5General Dynamics Information Technology, Silver Spring, Maryland, USA
  1. Correspondence to Tham Thi Le; tham.le{at}umaryland.edu

Abstract

Background Opioids and sedatives are commonly prescribed in chronic obstructive pulmonary disease (COPD) patients for symptoms of dyspnoea, pain, insomnia, depression and anxiety. Older adults are advised to avoid these medications due to increased adverse events, including respiratory events. This study examines respiratory event risks associated with concomitant opioid and sedative use compared with opioid use alone in older adults with COPD.

Methods A 5% nationally representative sample of Medicare beneficiaries with COPD and opioid use between 2009 and 2013 was used for this retrospective cohort study. Current and past concomitant use were identified using drug dispensed within 7 days from the censored date: at respiratory event, at death, or at 12 months post index. Concomitant opioid and sedative use were categorised into no overlap (opioid only), 1 to 10, 11 to 30, 31 to 60 and >60 days of total overlap. The primary outcome was hospitalisation or emergency department (ED) visits for respiratory events (COPD exacerbations or respiratory depression). Propensity score matching was implemented and semi-competing risk models were used to address competing risk by death.

Results Among 48 120 eligible beneficiaries, 1810 (16.7%) concomitant users were matched with 9050 (83.3%) opioid only users. Current concomitant use of 1 to 10, 11 to 30 and 31 to 60 days was associated with increased respiratory events (HRs (95% CI): 2.8 (1.2 to 7.3), 9.3 (4.9 to 18.2) and 5.7 (2.5 to 12.5), respectively), compared with opioid only use. Current concomitant use of >60 days or past concomitant use of ≤60 days was not significantly associated with respiratory events. Consistent findings were found in sensitivity analyses, including in subgroup analysis of non-benzodiazepine sedatives. Additionally, current concomitant use significantly increased risk of death.

Conclusion Short-term and medium-term current concomitant opioid and sedative use significantly increased risk of respiratory events and death in older COPD Medicare beneficiaries. Long-term past concomitant users, however, demonstrated lower risks of these outcomes, possibly reflecting a healthy user effect or developed tolerance to the effects of these agents.

  • COPD exacerbations
  • COPD epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000483

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    Footnotes

    • Contributors TTL, SP, MC, LSW and BK contributed to the conception of the study. Statistical analyses were done by TTL, SP and MW. All co-authors contributed to the interpretation of data. TTL wrote the first draft of the manuscript and all authors critically revised the manuscript and approved the submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Institutional Review Board (IRB) of the University of Maryland, Baltimore, approved this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. This study used the 5% Medicare claims called Chronic Conditions Data Warehouse provided by the Center for Medicare and Medicare Services (CMS). The data is de-identified claims, the re-use of the data is only guaranteed under an approved Data Use Agreement by the CMS. CMS website: https://www2.ccwdata.org/web/guest/home/CMS. Contact: HealthAPT, LLC. Attention: CCW Research Coordinator, 1401 50th Street, Suite 200, West Des Moines, IA 50266. Phone: 866-766-1915. Email: CCWhelp@gdit.com. Fax: 515-440-3159.