IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, NSW, 2007, Australia.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Drugs Aging. 2020 Apr;37(4):263-270. doi: 10.1007/s40266-020-00756-z.
Benzodiazepines, available clinically for almost six decades, are still one of the most widely prescribed classes of medication. The proportion of the population prescribed benzodiazepines increases with age, and harms also increase with age. The prevalence of prescribing in people > 85 years of age is as high as one in three, including in people with chronic obstructive pulmonary disease (COPD). The prevalence of COPD also increases with age. In COPD, indications cited for prescribing a benzodiazepine include anxiety, sleep disorders, or chronic breathlessness. Each of these symptoms is prevalent in the population with COPD, especially later in the course of the illness. For anxiety and insomnia, there is evidence to support short-term use, with little robust evidence to support prescribing for the symptomatic reduction of chronic breathlessness. People prescribed benzodiazepines are more likely to experience drowsiness or somnolence, exacerbations of their COPD, and respiratory tract infections. Furthermore, the longer people take benzodiazepines, the more likely they will become dependent on them. Prescribing patterns vary internationally but prescriptions of longer-acting benzodiazepines are declining in favour of shorter-acting compounds. Other evidence-based therapies that can more safely treat these problematic symptoms are available. For people already taking benzodiazepines, there are a number of interventions that have been shown to reduce the rate of prescribing. For people with COPD and not taking a benzodiazepine, but with symptoms where there is evidence of benefit, clinicians should weigh carefully the potential net benefit and prescribe at the lowest dose for the briefest time possible.
苯二氮䓬类药物在临床上已经使用了将近 60 年，仍然是使用最广泛的药物之一。开处苯二氮䓬类药物的人群比例随着年龄的增长而增加，危害也随着年龄的增长而增加。85 岁以上人群的开处率高达三分之一，包括慢性阻塞性肺疾病（COPD）患者。COPD 的发病率也随着年龄的增长而增加。在 COPD 中，开处苯二氮䓬类药物的指征包括焦虑、睡眠障碍或慢性呼吸困难。这些症状在 COPD 人群中都很常见，尤其是在疾病后期。对于焦虑和失眠，有证据支持短期使用，但对于减轻慢性呼吸困难的症状，几乎没有强有力的证据支持开处。开处苯二氮䓬类药物的患者更容易出现嗜睡或昏睡、COPD 加重和呼吸道感染。此外，人们服用苯二氮䓬类药物的时间越长，就越有可能对它们产生依赖。处方模式在国际上有所不同，但长效苯二氮䓬类药物的处方正在减少，而短期作用的化合物则在增加。还有其他一些基于证据的治疗方法可以更安全地治疗这些有问题的症状。对于已经服用苯二氮䓬类药物的患者，有许多干预措施已被证明可以降低开处率。对于没有服用苯二氮䓬类药物但有症状且有证据表明有获益的 COPD 患者，临床医生应仔细权衡潜在的净获益，并以最低剂量尽可能短暂地开处。
