New opioid use in older people with COPD associated with increased risk of breathing-related death
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Older people with chronic obstructive pulmonary disease begin to use opioids have more than twice as likely to die from a complication related to breathing compared to non-opioid users, researchers at St. Michael's hospital found.
When the researchers specifically examined the stronger opioids, they found the risk of death from breathing was five times higher for new opiate users compared with non-opioid users.
study, published today in the European Respiratory Journal , raises safety issues on the new use of opioids in the elderly with chronic diseases obstructive pulmonary disease or COPD, a progressive lung disease that causes breathing difficulties, said Dr. Nicholas Vozoris, pulmonologist author and leader St. Michael the study.
COPD affects approximately four to 10 percent of the Canadian population, the rate of five mortality between 40 and 70 percent, depending on the severity. The two-year mortality rate for people with severe COPD is approximately 50 percent.
The researchers examined the records of more than 130,000 Ontario adults 66 and older with COPD, using several administrative databases on the provincial health care at the Institute for Clinical Evaluative Sciences.
"previous research has shown that about three quarters of older people with COPD were prescribed opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to drugs "said Dr. Vozoris. "Our new results show that there is not only an increased risk of death associated with breathing associated with a new opioid use, but also an increased risk, visits to emergency rooms, hospital admissions and need antibiotics or steroid pills. "
Dr. Vozoris found that 68 percent of older people with COPD living in the community received a new prescription opioids between April 07 and March 2012. opioids such as codeine, oxycodone and morphine are commonly prescribed in elderly people with COPD to help treat chronic muscle and bone pain, persistent cough and shortness of breath despite inhalation therapy, and insomnia.
"This is a population that has a chronic lung disease with symptoms that can sometimes be difficult to manage," said Dr. Vozoris. "This class of drugs may offer some relief, but there is also evidence suggesting that opioids may impair breathing and lung health in people who have chronic lung compromise."
To lower the risk of adverse events in this population, the thought was to prescribe less powerful or less dosage of opioids. However, Dr. Vozoris and his team still found a significantly increased risk of complications and death among new consumers of respiratory related opiates, regardless of dose. "This finding is important because it has been thought that low doses of opioids may be safe for patients with COPD," said Dr. Vozoris.
Dr. Vozoris hope that clinicians take these findings into account when prescribing opioids for COPD patients. current guidelines recommend their use to manage respiratory symptoms difficult to control who can often compromise the quality of life of a patient, but the current data do not take not support the use of opioids for chronic pain.
"Sometimes patients are looking for a quick solution to the issues and chronic pain or respiratory physicians may believe opioids can offer them some relief, "said Dr. Vozoris." the compromise is explaining that there are risks for patients and ensure that they understand that potentially relieve their symptoms could come at a high cost to their health. "
Older people with chronic obstructive pulmonary disease begin to use opioids have more than twice as likely to die from a complication related to breathing compared to non-opioid users, researchers at St. Michael's hospital found.
When the researchers specifically examined the stronger opioids, they found the risk of death from breathing was five times higher for new opiate users compared with non-opioid users.
study, published today in the European Respiratory Journal , raises safety issues on the new use of opioids in the elderly with chronic diseases obstructive pulmonary disease or COPD, a progressive lung disease that causes breathing difficulties, said Dr. Nicholas Vozoris, pulmonologist author and leader St. Michael the study.
COPD affects approximately four to 10 percent of the Canadian population, the rate of five mortality between 40 and 70 percent, depending on the severity. The two-year mortality rate for people with severe COPD is approximately 50 percent.
The researchers examined the records of more than 130,000 Ontario adults 66 and older with COPD, using several administrative databases on the provincial health care at the Institute for Clinical Evaluative Sciences.
"previous research has shown that about three quarters of older people with COPD were prescribed opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to drugs "said Dr. Vozoris. "Our new results show that there is not only an increased risk of death associated with breathing associated with a new opioid use, but also an increased risk, visits to emergency rooms, hospital admissions and need antibiotics or steroid pills. "
Dr. Vozoris found that 68 percent of older people with COPD living in the community received a new prescription opioids between April 07 and March 2012. opioids such as codeine, oxycodone and morphine are commonly prescribed in elderly people with COPD to help treat chronic muscle and bone pain, persistent cough and shortness of breath despite inhalation therapy, and insomnia.
"This is a population that has a chronic lung disease with symptoms that can sometimes be difficult to manage," said Dr. Vozoris. "This class of drugs may offer some relief, but there is also evidence suggesting that opioids may impair breathing and lung health in people who have chronic lung compromise."
To lower the risk of adverse events in this population, the thought was to prescribe less powerful or less dosage of opioids. However, Dr. Vozoris and his team still found a significantly increased risk of complications and death among new consumers of respiratory related opiates, regardless of dose. "This finding is important because it has been thought that low doses of opioids may be safe for patients with COPD," said Dr. Vozoris.
Dr. Vozoris hope that clinicians take these findings into account when prescribing opioids for COPD patients. current guidelines recommend their use to manage respiratory symptoms difficult to control who can often compromise the quality of life of a patient, but the current data do not take not support the use of opioids for chronic pain.
"Sometimes patients are looking for a quick solution to the issues and chronic pain or respiratory physicians may believe opioids can offer them some relief, "said Dr. Vozoris." the compromise is explaining that there are risks for patients and ensure that they understand that potentially relieve their symptoms could come at a high cost to their health. "
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