December 6, 2012

expert reaction to new research into benzodiazepines and pneumonia

Commonly prescribed sedatives were linked to an increased the risk of contracting pneumonia by as much as 50%, according to research published in the journal Thorax.

Prof Donald Singer, member of the British Pharmacological Society and Professor of Clinical Pharmacology at the University of Warwick, said:

“This report suggests the need for caution, particularly in the longer term use of benzodiazepines. However the authors note that they cannot be sure whether their findings are cause and effect or have other explanations. For example, it was puzzling that risks from these drugs appeared lower in patients with more complex disease burden. There are also risks to stopping these medicines suddenly so patients with concerns should seek advice from their doctor or pharmacist”

Prof Simon Maxwell, University of Edinburgh, and Chair of the British Pharmacological Society’s Prescribing Committee, said:

“UK patient data, like those used in this study, can be exceptionally valuable for informing prescribing decisions. We will need further studies and continued monitoring of NHS patient data to give us a clearer picture of the actual relationship between the use of benzodiazepines and an elevated risk of pneumonia.”

Prof Peter Openshaw, Director of the Centre for Respiratory Infection, Imperial College London, said:

“We normally tell patients with chronic bronchitis that they should avoid using sleeping pills since these may cause respiratory suppression and inhibit coughing. The normal reflexes that help to clear secretions from the lungs at night may be inhibited.

“It seems likely that the effects described in this study are due to deep sleep caused by the drugs. This causes secretions being retained in the lungs, so that bacteria are not cleared so fast and cause infection. This seems more probable than the possible effects of the drugs on the immune system, which may or may not be important. It is also possible that those needing sleeping pills are more prone to pneumonia for other reasons, and that the link is not causal.

“Whatever the explanation, it’s an interesting paper and important finding.”

Dr Jodi Lindsay, Reader in Microbial Pathogenesis, St George’s, University Of London, said:

“The study shows an unexpected and intriguing association between benzodiazepines and pneumonia.  The next step will be to understand why.  This could lead to safer anxiety and sedative drugs as well as improving strategies for preventing and treating infections.”

‘The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort’ by Sanders et al., published in Thorax on Wednesday 5th December.