High Frequency of Benzodiazepine Use in COPD Concerning

Previous studies have linked benzodiazepines—a medication class that may be used in chronic obstructive pulmonary disease (COPD) to treat symptoms of insomnia, depression, anxiety, and shortness of breath—with adverse outcomes, but until now there has been little information on how frequently it’s prescribed or who is using it.

COPD, also known as emphysema or chronic bronchitis, is most commonly caused by smoking in North America and is estimated to affect 5% to 10% of the Canadian population. American Thoracic Society-European Respiratory Society guidelines recommend that benzodiazepines be avoided in these patients because of potential respiratory-related side effects.

Dr. Nicholas Vozoris is the lead author of a study published in Drugs and Aging looking at the scope of benzodiazepine use in the older adult COPD population to determine just how many people are using the drug.

“I see a large number of COPD patients taking this medication class to help relieve disease-related symptoms like insomnia, depression, and anxiety,” said Vozoris, a respirologist at St. Michael’s Hospital. “But considering the potential respiratory side effects, and the well-documented neurocognitive side effects like memory loss, decreased alertness, falls, and increased risk of motor vehicle accidents, the high frequency of benzodiazepine use in COPD is very concerning.”

Vozoris and colleagues looked at more than 100,000 adults 66 years and older with COPD in Ontario between 2004 and 2009 to see how many new benzodiazepines were dispensed and the severity of each patients’ COPD while on the drug.

The results found that new benzodiazepine dispensing was common and occurred in more than a third of the adults. Use of the drugs was 40% more common among those with more severe COPD. This group also had the highest number of repeat prescriptions and early refills, and benzodiazepines were also commonly dispensed to patients while they were having flare-ups of the disease.

“These findings are new, and they are concerning because they tell us that the patients most at risk to be affected by the adverse effects of this drug are the same ones who are using it with the most frequency,” Vozoris said. “This medication could be causing harm in this already respiratory-vulnerable population.”

Although benzodiazepines can be effective for helping patients sleep, this medication class has been previously found to affect breathing ability and oxygen levels at night.

“Patients need to hear this, and health care providers need to give thought into who they are prescribing this medication class to,” Vozoris said. “We’re talking about a very vulnerable sub-group and we may be inappropriately prescribing this medication class to those patients.”

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How Internet may be changing your brain

High levels of Internet use may change the brain in a way which could affect our attention, memory and social interactions, according to a study.

The research, found the Internet can produce both acute and sustained alterations in specific areas of cognition, which may reflect changes in the brain.

Researchers investigated leading hypotheses on how the Internet may alter cognitive processes, and further examined the extent to which these hypotheses were supported by recent findings from psychological, psychiatric and neuroimaging research.

“The key findings of this report are that high-levels of Internet use could indeed impact many functions of the brain,” said a researcher.

“For example, the limitless stream of prompts and notifications from the Internet encourages us towards constantly holding a divided attention — which then in turn may decrease our capacity for maintaining concentration on a single task,” he said.

Additionally, the online world now presents us with a uniquely large and constantly-accessible resource for facts and information, which is never more than a few taps and swipes away,” he said.

“Given we now have most of the world’s factual information literally at our fingertips, this appears to have the potential to begin changing the ways in which we store, and even value, facts and knowledge in society, and in the brain,” he said.

The widespread adoption of these online technologies, along with social media, is also of concern to some teachers and parents, researchers said.

The World Health Organization’s 2018 guidelines recommended that young children (aged 2-5) should be exposed to one hour per day, or less, of screen time.

However, the report also found that the vast majority of research examining the effects of the Internet on the brain has been conducted in adults.

More research is needed to determine the benefits and drawbacks of Internet use in young people, according to researchers.

He said although more research is needed, avoiding the potential negative effects could be as simple as ensuring that children are not missing out on other crucial developmental activities, such as social interaction and exercise, by spending too much time on digital devices.
“To help with this, there are also now a multitude of apps and software programmes available for restricting Internet usage and access on smartphones and computers — which parents and carers can use to place some ‘family-friendly’ rules around both the time spent on personal devices, and also the types of content engaged with,” he said.

“Speaking to children often about how their online lives affect them is also important — to hopefully identify children at risk of cyberbullying, addictive behaviours, or even exploitation — and so enabling timely intervention to avoid adverse outcomes,” he said.

The bombardment of stimuli via the Internet, and the resultant divided attention commonly experienced, presents a range of concerns, said a Prof.

“I believe that this, along with the increasing Instagramification of society, has the ability to alter both the structure and functioning of the brain, while potentially also altering our social fabric,” he  said.
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