Benzodiazepines do not relieve breathlessness in advanced COPD
MedWire News: A systematic review of published studies has found no evidence to suggest that treatment with benzodiazepines reduces breathlessness in patients with advanced chronic obstructive pulmonary disease (COPD).
Steffen Simon (Institute of Palliative Care, Oldenburg, Germany) and colleagues explain that breathlessness is a common and distressing symptom in patients with advanced disease, and is particularly prevalent in those with advance COPD and cancer.
Benzodiazepines, which are sedatives that are mainly used for the treatment of sleep disturbance and anxiety, are also widely used for the relief of breathlessness in advanced diseases, but the evidence for their efficacy in this respect is unclear.
To investigate further, the team searched the literature for randomized controlled trials and controlled clinical trials that assessed the effects of benzodiazepines for relieving breathlessness in patients with advanced diseases.
In total, seven studies, involving 200 patients with advance COPD (n=52) or cancer (n=148), met criteria for inclusion in the review.
Analysis of the data, including a meta-analysis of six of the seven studies, revealed that treatment with benzodiazepines had no significant beneficial effect for the relief of breathlessness in patients with either advanced COPD or cancer.
The researchers report that there was a slight, non-significant trend towards a beneficial effect on breathlessness, but the overall effect size was small.
Furthermore, benzodiazepine use was associated adverse effects – mainly drowsiness and somnolence.
Simon and team conclude: “There is no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in patients with advanced cancer and COPD.”
However, they add: “These results justify considering benzodiazepines as a second or third-line treatment within an individual therapeutic trial, when opioids and non-pharmacological measures have failed to control breathlessness.”
The study is published in the Cochrane Database of Systematic Reviews.
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By Mark Cowen