Antipsychotics associated with risk for acute respiratory failure in older patients with COPD
A case-crossover study of Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) found that risk for acute respiratory failure was higher within 14 days of antipsychotic use and increased with increasing age.
Use of antipsychotics may increase risk for acute respiratory failure (ARF) in older patients with chronic obstructive pulmonary disease (COPD), a recent study found.
Researchers used CMS data to conduct a case-control study of Medicare beneficiaries with COPD who were hospitalized with ARF from Jan. 1, 2007, through Dec. 31, 2019. The goal of the study was to evaluate whether recent use of oral antipsychotics was associated with higher ARF risk. Antipsychotic use was compared during the 14 days before the first eligible ARF episode (the case period) and during an earlier 14-day period (the control period). The study results were published Nov. 25 by the Journal of General Internal Medicine.
A total of 145,018 cases of ARF requiring mechanical ventilation within two days of admission were included in the study (mean age, 69.4 years; 57.2% female). Of these patients, 2,003 (1.4%) took oral antipsychotics only during the case period and 1,728 (1.2%) took them only during the control period. The adjusted odds ratio (OR) for ARF within 14 days after antipsychotic use was 1.13 (95% CI, 1.06, 1.20), with risk increasing with increasing age. Adjusted ORs were 1.37 (95% CI, 1.17 to 1.60) for those ages 75 to 84 years and 1.50 (95% CI, 1.20, 1.89) for those ages 85 years and older, but no statistically significant increase in risk was seen for those younger than age 75 years (adjusted ORs, 1.01 [95% CI, 0.85 to 1.20] for ages 18 to 49 years, 1.03 [95% CI, 0.92 to 1.15] for ages 50 to 64 years, and 1.12 [95% CI, 0.98 to 1.27] for ages 65 to 74 years).
The researchers noted that their study was likely to have included mostly patients with severe ARF and that the results in Medicare beneficiaries younger than age 65 years are not generalizable to U.S. adults without disabilities, among other limitations. They concluded that recent antipsychotic use by individuals with COPD who were at least 75 years of age was associated with increased risk for ARF. “These findings were consistent across multiple subgroup and sensitivity analyses,” the researchers wrote. “Healthcare providers should consider these findings when prescribing antipsychotics to older patients with COPD.”