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Deborah Leader, RN

Warning: Benzodiazapines May Be Risky in Severe COPD

By February 27, 2013

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A recent Canadian study reports that, despite being well-known to cause a slew of  respiratory complications, including respiratory depression, hypoxemia, hypercapnea, and decreased respiratory muscle strength and endurance, benzodiazapines (Ativan, Valium, Xanex) are being prescribed in droves to patients diagnosed with COPD.

Classified as an anti-anxiety medication, benzodiazapines are usually indicated for patients suffering from anxiety, panic attacks, insomnia and depression, all of which  commonly co-exist in people who have COPD. In COPD, they are also often prescribed to decrease the sensation of dyspnea.

According to International COPD guidelines, benzodiazapines are generally contraindicated for people in more severe stages of the disease, as the worse the disease-state, the more susceptible these patients are to adverse respiratory events. Never-the-less, findings from the study indicated that the more severe the COPD, the more the medication was prescribed.

As reported in Drugs and Aging, the 5-year study included 111,445 COPD patients, 66 years of age or older in the Ontario region. During the study period, 35,311 (31.7%) of participants were newly prescribed a benzodiazepine. Patients classified as having severe COPD (having had at least one emergency or hospital admission within the previous year) had a 42.2% greater chance of being prescribed a new prescription than patients with less severe COPD (having no hospital admissions during the previous year). Among new users, patterns of suboptimal benzodiazapine use were discovered, including:

  • 14.6% were prescribed long-acting agents.
  • 32.6% used the medication for longer than 30 days.
  • 30.6% received a second prescription.
  • 11.6% received an early refill.
  • 9% received a prescription while experiencing a COPD exacerbation.
  • Among patients with more severe disease, 35.4% used the medication during an exacerbation.

Authors of the study concluded that, because of these findings, additional research is necessary to investigate the long-term health outcomes among patients being prescribed benzodiazapines.

If you've received a prescription for benzodiazapines from your doctor, use it exactly as prescribed. Be sure you understand the risks associated with using this medication. If you have severe or very severe COPD, discuss the results of this study with your doctor. A non-benzodiazapine, such as Buspar, may be a safer alternative.

Have you received a prescription for benzodiazapines from your doctor? If so, how severe is your disease? Please answer this important question anonymously in the poll included above.


Vozoris NT, et. al. Benzodiazapine Use Among Older Adults with Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. Drugs Aging. 2013. Mar;30(3):183-92. doi: 10.1007/s40266-013-0056-1.

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February 28, 2013 at 3:33 pm
(1) Deb says:

I take ativan for my anxiety attacks and it works fine with the other drugs I also have to take. I am in the severe Copd stage and we all know what’s down the road for me. Why would I want to switch to something safer now. The ativan is fine with me.

February 28, 2013 at 6:10 pm
(2) Helen says:

My pulmonary doctor prescribes .25 mg aprazolam twice daily if needed for my severe anxiety disorder. I also have severe COPD but wouldn’t even be able to leave my house without this drug. There have been no problems to date and I feel the positives far outweigh the possible negative effects as far as quality of life.

March 4, 2013 at 11:08 pm
(3) mikos55 says:

The results of this research has me quite upset. I am doing all I can do to strengthen my respiratory muscles and I follow a fairly steady regimen of exercise. It seems that the results of this study indicate I am wasting my time as the alprzalom I am taking is basically nullifying my physical rehab. Also, I am taking at least 3 grams of alprrazalom within a 24 hour period. I will be addressing this issue with my nurse and PCP tomorrow.

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