Is Buspar (buspirone) safe for a patient with Chronic Obstructive Pulmonary Disease (COPD) to treat anxiety?

Buspirone for Anxiety in COPD Patients

Buspirone is safe and appropriate for treating anxiety in patients with COPD, as it does not suppress respiration and is well-tolerated when combined with bronchodilators. 1

Why Buspirone is Preferred in COPD

Buspirone should be strongly considered over benzodiazepines for anxiety management in COPD patients because benzodiazepines carry significant risks including respiratory depression, increased all-cause mortality in severe COPD, falls, delirium, and CNS impairment. 2

Key Safety Advantages

• Buspirone does not suppress respiratory drive, making it fundamentally safer than benzodiazepines in patients with compromised pulmonary function 1
• It is well-tolerated when coprescribed with bronchodilators including theophylline and terbutaline, with only slightly higher rates of dizziness (8.5%) compared to patients not on bronchodilators 3
• SSRIs and buspirone have relatively little potential for significant adverse effects in pulmonary patients compared to sedating medications 1

Evidence for Efficacy

The evidence for buspirone's effectiveness specifically in COPD-related anxiety shows mixed results:

• Buspirone has been found to reduce symptoms of anxiety in trials involving COPD patients 4
• However, one controlled trial showed no significant improvement in anxiety scores or exercise tolerance in patients with mild to moderate anxiety and chronic airflow obstruction after 6 weeks of buspirone 10-20 mg three times daily 5
• In an open study of 82 anxious patients on bronchodilators, buspirone 5 mg three times daily showed substantial improvement as measured by physician and patient ratings 3

Recommended Treatment Algorithm

For COPD patients with anxiety, follow this approach:

1. First-line: Non-pharmacological interventions including breathing-relaxation training, hand-fan directed at face for acute episodes, and pulmonary rehabilitation programs with psychological support components 2, 6

2. Second-line: Buspirone or SSRIs for ongoing anxiety management, as they have better safety profiles than benzodiazepines 2, 1

   • Buspirone dosing: Start 5 mg three times daily, can increase to 10-20 mg three times daily 5, 3
   • SSRIs (such as sertraline) are also effective for reducing anxiety symptoms 4

3. Avoid benzodiazepines except as second- or third-line therapy in acute episodes when other measures have failed, due to respiratory depression risk and increased mortality 2

Critical Clinical Pitfalls to Avoid

• Do not reflexively prescribe benzodiazepines despite their common use—the risks far outweigh benefits in COPD patients, particularly elderly patients 2
• Do not use anticholinergic medications for anxiety, as they cause CNS impairment and delirium 2
• Recognize that anxiety and dyspnea create a vicious cycle—patients experience fear in anticipation of dyspnea episodes, which creates heightened physiologic arousal that precipitates or exacerbates dyspnea 2
• Screen for depression alongside anxiety, as 45% of elderly COPD patients have depressive symptoms that are significantly undertreated 2

Additional Considerations

Many elderly patients refuse psychiatric medications due to fear of side effects, embarrassment, denial, addiction concerns, or frustration with polypharmacy—address these concerns directly 2

Cognitive-behavioral programs focusing on relaxation and changes in thinking have been shown to produce declines in anxious symptoms and can be particularly useful in patients with concomitant respiratory disease 4, 1