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dc.contributor.authorLe, T.T.
dc.contributor.authorPark, S.
dc.contributor.authorWijesinha, M.
dc.contributor.authorSimoni-Wastila, L.
dc.date.accessioned2020-04-14T14:28:49Z
dc.date.available2020-04-14T14:28:49Z
dc.date.issued2020
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85082677677&doi=10.1136%2fbmjresp-2019-000483&partnerID=40&md5=cece730e3af04cc7a70fcfa2cb9f4b07
dc.identifier.urihttp://hdl.handle.net/10713/12545
dc.description.abstractBackground 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. Copyright Author(s)en_US
dc.description.urihttps://doi.org/10.1136/bmjresp-2019-000483en_US
dc.language.isoen_USen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofBMJ Open Respiratory Research
dc.subjectCOPD epidemiologyen_US
dc.subjectCOPD exacerbationsen_US
dc.titleRespiratory events associated with concomitant opioid and sedative use among Medicare beneficiaries with chronic obstructive pulmonary diseaseen_US
dc.typeArticleen_US
dc.identifier.doi10.1136/bmjresp-2019-000483


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