| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 105 === Part I: The use of benzodiazepine receptor agonists and risk of respiratory failure in patients with chronic obstructive pulmonary disease
Background: Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD), and benzodiazepine receptor agonists (BZRAs) are the most commonly used drugs despite their adverse effects on respiratory function. The aim of this study was to investigate whether the use of BZRAs was associated with an increased risk of respiratory failure (RF) in COPD patients.
Methods:
- Design: Matched case-control study.
- Setting: National Health Insurance Research Database (NHIRD) in Taiwan.
- Participants: The case group consisted of 2,434 COPD patients with RF, and the control group consisted of 2,434 COPD patients without RF, matched for age, sex, and date of enrollment.
- Measurements: Exposure to BZRAs during the 180-day period preceding the index date was analyzed and compared in the case and control groups. Conditional logistic regression was performed to evaluate the association between the use of BZRAs and risk of RF.
Results: The use of BZRAs was associated with an increased risk of respiratory failure (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.14–2.13). In subgroup analysis, we found that the benzodiazepine (BZD) users had a higher risk of RF (aOR 1.58, 95% CI 1.14–2.20), whereas the risk in non-benzodiazepine (non-BZD) users was insignificant (aOR 0.85, 95% CI 0.51–1.44). A greater than 2-fold increase in risk was found in those who received two or more kinds of BZRAs and those using a combination of BZD and non-BZD medications.
Conclusions: The use of BZRAs was a significant risk factor for RF in patients with COPD. Compared to BZDs, the prescription of non-BZDs may be safer for the management of insomnia in COPD patients.
Part II: Influenza vaccination and risk of respiratory failure in patients with chronic obstructive pulmonary disease
Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease that causes a considerable burden on global health care systems. Patients with COPD are at a higher risk for respiratory tract infection. Influenza virus is an important trigger of the latter, resulting in exacerbation and other serious complications of COPD. We evaluated the association between influenza vaccination and the risk of respiratory failure (RF) in COPD patients.
Methods: Patients with newly diagnosed COPD were identified from the National Health Insurance Research Database (NHIRD) in Taiwan in 20012005 and were followed until 2010. We explored the influenza vaccination rate in COPD patients, and defined those who experienced RF as the case group, and the remainder as the control group. Baseline characteristics were compared between groups, and logistic regression was used to evaluate the association between influenza vaccination and RF.
Results: The influenza vaccination rate was significantly higher in patients aged ≥ 65 years than those aged < 65 years (54.8% vs. 4%, p < 0.001). The vaccine cohort had more comorbidities and more OPD visits and hospitalizations than did the nonvaccine cohort. Multivariable logistic regression revealed that influenza vaccination was associated with a reduced risk of RF (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.79–0.96). In subgroup analysis, we found that the association was still significant among patients aged ≥ 65 years (aOR 0.89, 95% CI 0.80–0.98), patients without acute exacerbation in the previous year (aOR 0.87, 95% CI 0.78–0.97), and patients who received influenza vaccine annually (aOR 0.74, 95% CI 0.57–0.96).
Conclusions: Influenza vaccination was associated with a decreased risk of RF in patients with COPD. Annual influenza vaccination should be recommended to this high-risk patient group. Further large-scale studies are warranted to investigate the efficacy of influenza vaccination in adults with COPD.
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