Predictors of opioid-related adverse pulmonary events among older adults with chronic obstructive pulmonary disease

Rationale — Although opioids are frequently prescribed in chronic obstructive pulmonary disease (COPD), there is poor understanding regarding which individuals will experience pulmonary harm upon exposure.

Objectives — We sought to identify patient characteristics and opioid drug properties predictive of opioid-related adverse pulmonary events among older adults with chronic COPD.

Methods — A retrospective, population-based, cohort study design was used, analyzing Ontario heath administrative data. Individuals aged 66 years and older, with validated, physician-diagnosed COPD receiving a new opioid drug were included. Adverse pulmonary events (defined as an emergency room visit, hospitalization or death related to either COPD or pneumonia) occurring within 30 days following new opioid receipt were considered. Multivariable-adjusted, cause-specific hazard modelling was used to identify predictors of adverse pulmonary events.

Results — Out of 169,517 older adults with COPD receiving a new opioid, 4861 (2.9%) experienced an adverse pulmonary event within 30 days. Factors independently predisposing to adverse pulmonary events included: older age (>85 years old: hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.26-1.49); long-term care home residence (HR 1.32; 95% CI 1.21-1.44); severe COPD exacerbation within the preceding year (HR 2.96; 95% CI 2.77-3.17); comorbidities (including non-COPD lung disease [HR 1.16; 95% CI 1.09-1.23], congestive heart failure [HR 1.22; 95% CI 1.14-1.30], sleep disorder [HR 1.22; 95% CI 1.15-1.30] and dementia [HR 1.14; 95% CI 1.05-1.24]); other psychoactive medication receipt, including benzodiazepines (HR 1.27; 95% CI 1.19-1.35) and serotonergic antidepressants (HR 1.10; 95% CI 1.03-1.19); and, receipt of an opioid-only agent (HR 1.35; 95% CI 1.26-1.46). Factors that independently protected from adverse pulmonary events included: female sex (HR 0.78; 95% CI 0.73-0.82); surgery within the preceding year (HR 0.70; 95% CI 0.64-0.77); and, musculoskeletal disease (HR 0.75; 95% CI 0.70-0.80). No significant associations were observed between adverse pulmonary events and opioid half-life duration or opioid daily dosage.

Conclusions — Patient and opioid drug factors predictive of opioid-related adverse pulmonary events among older adults with COPD were identified, which may assist with safer opioid prescribing.