King's College London

Safety concerns are a barrier to prescribing benzodiazepines (BDZ) and opioids in Interstitial Lung Disease (ILD). We therefore examined association of BDZ and opioids on risk of admission to hospital and death. We conducted a population based longitudinal cohort study of fibrotic ILD patients starting Long Term Oxygen Therapy in Sweden 2005-2014. Effects of BDZ and opioids on rates of admission to hospital and mortality were analysed using Fine-Gray and Cox regression whilst adjusting for potential confounders. We included 1,603 patients (61% women). BDZ were used by 196 (12%), opioids by 254 (15%). There was no association between BDZ and increased admission. Treatment with higher vs lower dose BDZ was associated with increased mortality: (SHR 1·46, 95% CI 1·08 to 1·98) vs (SHR 1·13, 95% CI 0·92 to 1·38). Opioids showed no association with increased admission. Neither low dose opioids (<30mg/day morphine equivalent) (SHR 1·18 (95% CI 0.96 to 1·45) nor high dose opioids (>30mg/day morphine equivalent) (SHR 1·11 (95% CI 0·89 to 1·39) showed association with increased mortality. This first ever study to examine associations between BDZ and opioid use and harm in ILD supports the use of opioids and low dose BDZ in severely ill patients with respiratory compromise.