Opioid use in older adults with COPD can lead to respiratory harm

Factors such as advanced age and recent severe exacerbation may predict opioid-related pulmonary events in older adults with COPD, according to a study published in Annals of the American Thoracic Society.

“While there is some evidence supporting opioids having modest benefits to limited individuals with COPD experiencing difficult to control dyspnea, it is also known that using opioid drugs in the COPD population can lead to respiratory harm,” Nicholas T. Vozoris, MD, MHSc, assistant professor and clinician investigator in the division of respirology at the department of medicine and Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toronto, told Healio.

Researchers conducted a retrospective, population-based cohort study that included 169,517 adults aged at least 66 years with physician-diagnosed COPD who were receiving a new opioid drug. Vozoris and colleagues aimed to identify patient characteristics and opioid drug properties that are predictive of adverse pulmonary events associated with opioid use in this population. Adverse pulmonary events were defined as an ED visit, hospitalization or death related to COPD or pneumonia that occurred within 30 days after new opioid receipt.

A multivariable-adjusted, cause-specific hazard model was used to assess predictors of adverse pulmonary events.

Within 30 days, 2.9% of patients experienced an adverse pulmonary event.

The researchers identified several predictors independently predisposing to adverse pulmonary events in this population, including:

• older age (HR = 1.37; 95% CI, 1.26-1.49);
• long-term care in a home residence (HR = 1.32; 95% CI, 1.21-1.44);
• severe COPD exacerbation in the previous year (HR = 2.96; 95% CI, 2.77-3.17);
• comorbidities such as non-COPD lung disease (HR = 1.16; 95% CI, 1.09-1.23), congestive heart failure (HR = 1.22; 95% CI, 1.14-1.3), sleep disorder (HR = 1.22; 95% CI, 1.15-1.3) and dementia (HR = 1.14; 95% CI, 1.05-1.24);
• receipt of other psychoactive medications such as benzodiazepines (HR = 1.27; 95% CI, 1.19-1.35) and serotonergic antidepressants (HR = 1.1; 95% CI, 1.03-1.19); and
• receipt of an opioid-only agent (HR = 1.35; 95% CI, 1.26-1.46).

Additionally, the researchers identified factors that independently protected from adverse pulmonary events, including female sex (HR = 0.78; 95% CI, 0.73-0.82), surgery in the previous year (HR = 0.7; 95% CI, 0.64-0.77) and musculoskeletal disease (HR = 0.75; 95% CI, 0.7-0.8).

Researchers observed no association between adverse pulmonary events and opioid half-life duration or daily dosage.

“Among nonpalliative older adults with COPD, our study results support that opioids be cautiously prescribed among individuals with the aforementioned patient characteristics and that opioid-only drug formulations be used with heightened vigilance,” Vozoris said.

The researchers concluded that more research is needed to clarify which patients with COPD are helped and which are harmed by opioid use.

“Better understanding mechanisms why individuals with COPD might be helped from opioids in terms of their breathing comfort is also an area worthy of further research,” Vozoris told Healio.

For more information:

Nicholas T. Vozoris, MD, MHSc, can be reached at nick.vozoris@utoronto.ca.