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The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort
  1. Usman Iqbal1,
  2. Shabbir Syed-Abdul1,2,
  3. Phung Anh Nguyen1,2,
  4. Wen-Shan Jian3,
  5. Yu-Chuan (Jack) Li1
  1. 1College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
  2. 2Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan
  3. 3School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Yu-Chuan (Jack) Li, College of Medicine Science and Technology, Taipei Medical University, Wan Fang Hospital, 250 Wu-Hsing Street, Xinyi District, Taipei city 11031, Taiwan; jack{at}

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The use of benzodiazepines is not associated with community-acquired pneumonia

We read with interest the recent study done by Obiora et al1 about the incidence and mortality with pneumonia for benzodiazepine users verses non-benzodiazepine users. We were interested to see whether these results would be generalisable to the Taiwanese population, therefore, we used the National Health Insurance Database of 22 million (2002) population in order to investigate the association of benzodiazepines and community-acquired pneumonia (CAP). We selected window size of 1, 2 and 3 months to compute odds ratios of the diagnosis of pneumonia and presence of benzodiazepine prescription filling in all age and sex groups. We took patients having CAP identified through ICD-9-CM (480–486) codes (International Classification of Diseases, Ninth Revision, and Clinical Modification) and identified medications from their prescription using ATC (Anatomical Therapeutic Chemical) drug classification codes (N05BA01, N05BA02, N05BA06) system for benzodiazepines.

However, we found no significant association between benzodiazepines use with CAP for 30, 60 and 90 days while computing the odds ratios,2 as shown in table 1. We checked benzodiazepines separately and in combination, but still, there was no association found for benzodiazepines being associated with CAP. Although there are not much studies about benzodiazepines in relation to pneumonia; however, added to our results, Dublin et al3 found in geriatrics that there is no risk for pneumonia while using benzodiazepines. Trifirò et al4 studied specifically typical and atypical antipsychotic drugs use, and risk for pneumonia in the elderly population; they also did not find any significant relationship with regard to benzodiazepines. Our result supports Dublin and Trifiro, which are contradictory to the Obiora et al study, that there is no significant relationship found between using benzodiazepines and having incidence risk for pneumonia.

Table 1

Association between benzodiazepines use and community acquired pneumonia

We believe that our findings would contribute to the discussion on this topic. It is important, however, to emphasise the need for randomised controlled trials for benzodiazepines use and incidence of CAP in patients to demonstrate any causal relationship in terms of morbidity and mortality of having pneumonia while using benzodiazepines.


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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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    Robert D Sanders