O7.12 Alcohol and sedatives

Patients with COPD have impaired gas exchange and an exaggerated fall in Po2 with recumbency and sleep onset (Meecham Jones 1995Chaouat 1995). Excessive use of alcohol and sedatives exacerbates this and predisposes to sleep-disordered breathing.

Heavy cigarette smoking is associated with misuse of other substances in many individuals. Nicotine, caffeine and alcohol also predispose to gastro-oesophageal reflux.

In a population-based cohort of 130,979 community-dwelling older adults with COPD, new opioid users were associated with significantly increased risk of emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00–1.29; p=0.04). Opioid use was also associated with significantly increased risk for COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61–2.88) and all-cause mortality (HR 1.76, 95% CI 1.57–1.98), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83–0.94; p=0.0002). New opioid use and, in particular, use of the generally more potent opioid-only agents, was associated with increased adverse respiratory outcomes and mortality. A careful, individualised approach needs to be taken when administering opioids to older adults with COPD, given the potential for adverse respiratory outcomes (Vozoris 2016).