Antipsychotic Use Among COPD Patients May Up ARF Risk
Clinicians should exercise caution and avoid high doses when prescribing antipsychotics to patients with COPD.
According to a study published in JAMA Psychiatry, the use of antipsychotics was associated with an increased risk of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD).
The association between antipsychotic use and acute respiratory failure has been seen in case reports but lacks population-based evidence. Meng-Ting Wang, PhD, from the National Defense Medical Center, Taipei, Taiwan, Republic of China, and colleagues set out to determine whether the use of antipsychotics was associated with a higher risk of acute respiratory failure in patients with COPD.
They conducted a population-based case-crossover study analyzing the Taiwan National Health Insurance Research Database in all patients with COPD who were newly diagnosed with ARF from January 1, 2000 to December 31, 2011. Antipsychotic use was self-compared during Days 1–14 (case period) and Days 75–88 (control period) before the ARF incidence or index date. Dr. Wang and authors examined the antipsychotic class, route of administration, and dose.
The analysis showed 5,032 patients with ARF among the 61,620 total patients with COPD. Close to 12% of patients with ARF (n=590) filled at least one antipsychotic drug during the case period vs. 8.8% (n=443) during the control period, which indicated a 1.66-fold (95% CI: 1.34-2.05; P<0.001) adjusted increased risk of ARF regardless of drug class or route of administration.
A dose-dependent risk for ARF associated with antipsychotics was seen (adjusted odds ratio [aOR] 1.35, 95% CI: 1.19–1.52; P<0.001), which rose from a 1.52-fold risk to a 3.74-fold risk for a high dose (95% CI: 1.68–8.36; P=0.001).
"Clinicians should exercise caution when prescribing antipsychotics to patients with COPD and avoid high doses if possible," stated Dr. Wang.