Low-Dose Opioids Safe in Severe COPD, Benzodiazepines Less So

By Amy Orciari Herman

Low-dose opioids may be safely used to reduce breathlessness in patients with severe chronic obstructive pulmonary disease, a BMJ study finds.

Using Swedish registries, researchers followed roughly 2200 patients starting long-term oxygen therapy for COPD. Some 40% were using benzodiazepines, opioids, or both at baseline.

During a median 2.5 months’ follow-up, three-quarters of all patients were hospitalized. Use of benzodiazepines or opioids was not associated with increased admission rates. After 1 year, half of all patients had died. Benzodiazepines were associated with a 20% increase in mortality, as were high-dose opioids. Lower-dose opioids (30 mg or less of oral morphine equivalents/day), however, did not increase mortality.

The researchers say their research “supports the safety of regular low dose systemic opioids to reduce breathlessness in severely ill patients with respiratory compromise.” They add that “benzodiazepines should not be the first line treatment … given the unclear evidence of net clinical benefit.”