Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults

Simon, Steffen T.; Higginson, Irene J; Booth, Sara; Harding, Richard; Weingärtner, Vera; Bausewein, Claudia

doi:10.1002/14651858.cd007354.pub3

Cited by 160 publications

(82 citation statements)

References 108 publications

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“…We previously found greater use of benzodiazepines among older adults with frequent vs. infrequent COPD exacerbations [50]. The findings of lower opioid use, but higher benzodiazepine use, among older adults with frequent exacerbations vs. infrequent exacerbations are interesting as opioids might have a role in mitigating refractory dyspnoea in advanced COPD [26][27][28][29][30][31], whereas benzodiazepines do not [51]. Our finding of relatively lower incident opioid use among long-term care residents compared to the community-dwelling individuals is somewhat surprising as others have previously reported the opposite [5].…”

Section: Discussionmentioning

confidence: 94%

Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population‐based cohort study

Vozoris

Wang

Fischer

et al. 2015

Brit J Clinical Pharma

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AIMSThe purpose of the present study was to describe the scope, pattern and patient characteristics associated with incident opioid use among older adults with chronic obstructive pulmonary disease (COPD). METHODSThis was a retrospective population-based cohort study using Ontario, Canada, healthcare administrative data. Study participants were individuals aged 66 years and older with physician-diagnosed COPD, identified using a validated algorithm, who were not receiving palliative care. We examined the incidence of oral opioid receipt between 1 April 2003 and 31 March 2012, as well as several patterns of incident opioid drug use. RESULTSAmong 107 109 community-dwelling and 16 207 long-term care resident older adults with COPD, 72 962 (68.1%) and 8811 (54.4%), respectively, received an incident opioid drug during the observation period. Among long-term care residents, multiple opioid dispensings (8.8%), dispensings for >30 days' duration (up to 19.8%), second dispensings (35-43%) and early refills (24.2%) were observed. Incident opioid dispensing was also observed to occur during COPD exacerbations (6.9% among all long-term care residents; 18.1% among long-term care residents with frequent exacerbations). These same patterns of incident opioid use occurred among community-dwelling individuals, but with relatively lower frequencies. CONCLUSIONSNew opioid use was high among older adults with COPD. Potential safety concerns are raised by the degree and pattern of new opioid use, but further studies are needed to evaluate if adverse events are associated with opioid drug use in this older and respiratory-vulnerable population.

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Section: Discussionmentioning

confidence: 94%

Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population‐based cohort study

Vozoris

Wang

Fischer

et al. 2015

Brit J Clinical Pharma

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“…7 Table 2 gives an overview of symptom control in patients with COVID-19 infection. [8][9][10][11][12][13] Patients with difficult-to-control symptoms / other problems should be referred to / discussed with the local specialist palliative care team in a timely manner (and advice from these teams should be available 24 hours per day / 7 days per week).…”

Section: Guidelinesmentioning

confidence: 99%

Palliative care in the context of a pandemic: similar but different

Davies

Hayes

2020

Clinical Medicine

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Palliative care is an important component of the medical response to pandemics and other health emergencies. The principles of palliative care do not change, but the practice of palliative care has to change as a result of factors such as greater demand and infection control measures. This article makes suggestions for palliative care provision during a pandemic (in developed countries), based on a limited review of the literature and personal experience of the ongoing pandemic (COVID-19 infection).

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“…One quarter of respondents recommended benzodiazepines, long-term low dose prednisolone, nebulised bronchodilators or theophylline as first-line treatments for chronic refractory breathlessness, even though there is no evidence to support these interventions and they are not part of COPD guidelines. 1,23 As many of those treatments are associated with significant side-effects and risks, there is a demonstrated need for further education of junior doctors regarding evidence-based, pharmacological management of refractory breathlessness.…”

Section: Other Pharmacological Treatmentsmentioning

confidence: 99%

Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

Smallwood

Gaffney

Gorelik

et al. 2017

Internal Medicine Journal

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This is the first study of doctors to demonstrate high awareness, confidence, willingness and experience in prescribing opioids for the off-licence indication of refractory breathlessness in COPD. These findings differ significantly from attitudes reported overseas and are unexpected given the doctors surveyed were recently qualified. The low awareness of possible adverse events and limited insight regarding knowledge gaps is concerning and highlights the significant need for greater education in palliative care.

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Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults

Cited by 160 publications

References 108 publications

Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population‐based cohort study

Incident opioid drug use among older adults with chronic obstructive pulmonary disease: a population‐based cohort study

Palliative care in the context of a pandemic: similar but different

Junior doctors’ attitudes to opioids for refractory breathlessness in patients with advanced chronic obstructive pulmonary disease

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