OBJECTIVES

Evidence regarding the short-term risk of COPD exacerbation from transient opioid exposure has been found among adult patients under 65 years old, but this relationship has not been evaluated among older adults in the U.S. The objective of this study was to examine the association of transient opioid use and COPD exacerbations among older Medicare beneficiaries with COPD.

METHODS

This study used 5% national Medicare claims data from 2012-2016. A case-crossover design was employed to evaluate the impact of short-term opioid exposure on abrupt COPD exacerbations with each subject serving as their own control. The study population included enrollees in the Medicare fee-for-service program who were diagnosed with COPD and had an acute COPD exacerbation between July 1^st, 2012 and December 31^st, 2016. The impact of opioid use in the seven days immediately prior to COPD exacerbation was compared to opioid exposure in ten control windows prior to this case window. Adjusted odds ratios (OR) were estimated using conditional logistic regression models to assess the risk of opioid use on COPD exacerbations after controlling for time-varying use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Recurrent exacerbation on the same individual was allowed. The robust sandwich estimate for the covariance matrix was utilized to account for the within-subject dependence.

RESULTS

A total of 57,542 COPD exacerbation events occurred among the 37,089 beneficiaries who met study inclusion criteria. Opioid exposure in the seven days before an acute COPD exacerbation was significantly associated with the exacerbation (OR: 3.02 [95% CI: 2.94, 3.11]). Transient use of inhaled bronchodilators, methylxanthines, inhaled corticosteroids, systemic corticosteroids, benzodiazepines, and β-blockers were also found to be associated with increased odds of acute COPD exacerbation.

CONCLUSIONS

Opioids can exacerbate COPD among older adults even when used short-term. Guidelines recommending use of opioids in this population may need to be revisited.