Gender differences in benzodiazepines prescription in old age patients

Objectives

To assess the prescription of benzodiazepines (BZD) in elderly patients, and to explore any gender differences.

Methods

Six hundred and fifty-four patients (≥ 65) admitted in an emergency service of a general hospital due to a fall. BZD use information was collected (dose, half-life profile).

Results

BZD are significantly more prescribed to women (47.6%) than men (36.1%) (X2 = 8.097, P = 0.004). We conducted a logistic regression analysis using as dependent variable taking or not BZD and sex as the independent one, covariating the model by age. We noted that sex remains significant despite enter the age variable in the model (OR = 1.5, P = 0.013). A total of 21.6% of patients consumed intermediate or long half-life BZDs, appearing a greater tendency to prescribe such BZD to women (X2 = 3.606, P = 0.058). In the 58.0% of prescriptions, prescribed dose was higher than the recommended for the elderly. The percentage is significantly higher for men (70.0%) than women (53.1%). Furthermore, a total of 54 prescriptions (15.8%) were even higher than the recommended adult dose, with no significant differences between men and women.

Conclusions

We found evidence of a higher prescription of BZD in women independently of age. Despite not being recommended, prescription of intermediate or long half-life BZD continues, in a slightly higher manner in women. BZD are prescribed above the recommended dose for elderly in a large number of patients, especially in men. A considerable proportion of elderly patients (15.8%) consume BZD doses even higher than the recommended for adults.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Maximal response plateau to adenosine 5'-monophosphate in asthma. Relationship with the response to methacholine, exhaled nitric oxide, and exhaled breath condensate pH

BACKGROUND

No information is available on the plateau in response to adenosine 5'-monophosphate(AMP). The aims of the present study were (1) to determine whether plateau can be detected with AMP and the relation with the plateau in response to methacholine, and (2) to identify the relation between the plateau and indirect markers of airway inflammation, such as exhaled nitric oxide (ENO) and exhaled breath condensate (EBC) pH.

METHODS

Airway responsiveness to high concentrations of methacholine and AMP, ENO levels, and EBC pH values were obtained in 31 subjects with well-controlled asthma. Concentration-response curves were characterized by their concentration of agonist that produces a decrease in FEV(1) of 20% and, if possible, by the level of plateau.

RESULTS

Although the prevalence of plateau with methacholine (48%) and AMP (58%) was similar, the two challenges did not identify plateau in exactly the same individuals. In 14 subjects who showed plateau with both bronchoconstrictor agents, the mean plateau level for methacholine was 26.0% (95% confidence interval [CI], 21.3 to 30.8), compared with 16.5% (95% CI, 12.2 to 20.8; p < 0.0001) for AMP. Both ENO and EBC pH values were similar in subjects with plateau and in those without plateau.

CONCLUSIONS

In well-controlled asthmatics, the plateau in response to AMP can be identified at a milder degree of obstruction than the plateau in response to methacholine, but the two agonists are not identifying the same airway abnormalities. Furthermore, if ENO and EBC pH are markers of inflammation, the determination of the presence or level of plateau is not a reliable method to identify airway inflammation in asthma.