SEATTLE — Symptoms of insomnia and anxiety are common among patients with chronic obstructive pulmonary disease, and that is especially the case among patients with comorbid mental health disorders such as posttraumatic stress disorder, according to a new study.

A report in the Annals of the American Thoracic Society pointed out that benzodiazepines provide temporary relief of these symptoms, but guidelines discourage routine use of the drugs because of serious risks associated with them.

Puget Sound VA Healthcare System-led researchers emphasized that a more thorough understanding of guideline-discordant benzodiazepine is essential to reduce potentially inappropriate prescribing and its associated risks.

To accomplish that, the study team examined the national prevalence, variability and center correlates of long-term benzodiazepine prescriptions for patients with COPD and comorbid PTSD.

The focus was on VA patients with COPD and PTSD who received care between 2010-2012. The authors examined predictors of long-term benzodiazepine prescriptions, defined as 90 days or more, while also accounting for patient characteristics.

The study found that, of 43,979 patients diagnosed with COPD and PTSD at 129 centers, 24.4% were prescribed benzodiazepines long-term, with use varying from 9.5-49.4% by medical center.

Results also indicated that patients with long-term prescriptions were more likely to be white (90.1% vs. 80.7%) and have other mental health comorbidities including generalized anxiety disorder (31.3% vs. 16.5%). Accounting for patient mix and characteristics, long-term benzodiazepine use was associated with lower patient-reported access to mental health care (OR 0.54, 95%CI 0.37-0.80), researchers added.

“Long-term benzodiazepine prescribing is common among patients at high risk for complications, although this practice varies substantially from center to center,” the study authors concluded. “Poor access to mental health care is a potential driver of this guideline inconsistent use.”

  1. Donovan LM, Malte CA, Spece LJ, Griffith MF, et. Al. Center Predictors of Long-Term Benzodiazepine Use in Chronic Obstructive Pulmonary Disease and Posttraumatic Stress Disorder. Ann Am Thorac Soc. 2019 May 22. doi: 10.1513/AnnalsATS.201901-048OC. [Epub ahead of print]