Reviews and feature articleAirway obstructive diseases in older adults: From detection to treatment
Section snippets
Definitions
The definition COPD has evolved in the last decade. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defined COPD as a preventable disease with extrapulmonary effects characterized by progressive airflow limitation that is not fully reversible associated with an abnormal inflammatory response.8 This contrasts with the earlier definition of COPD (American Thoracic Society) that required the presence of chronic bronchitis (determined clinically) or emphysema (determined
Spirometry in older adults
Spirometry is necessary to establish the presence of airflow obstruction and to classify the severity of the obstructive defect in COPD. Guidelines for standardization and interpretation of pulmonary function tests are widely available, and in the majority of adult subjects, acceptable and repeatable spirometric maneuvers can be achieved. Nevertheless, several pitfalls must be considered when performing and interpreting spirometry in the elderly.
Disease burden
The prevalence of COPD in the general population increases with age. The Burden of Obstructive Lung Disease initiative reported the prevalence of COPD in different parts of the world (n = 9245). The prevalence of GOLD-defined COPD stage II (FEV1/FVC ratio <0.70 and FEV1 <80% of the predicted value) or higher was 11.8% for male and 8.5% for female subjects. The study also showed an increased risk of COPD that approximately doubled for each 10-year age increment over the age of 40 years.15 The
Clinical manifestations and diagnostic challenges
In clinical practice, differentiation of asthma and COPD is based on the patient's history and pulmonary function testing (Table I). Nevertheless, many factors complicate establishing the diagnosis among older adults. For example, it is known that longstanding asthma can lead to airway remodeling and partly irreversible airflow obstruction9; therefore, older adults with a history of asthma may develop clinical features suggestive of COPD. A longitudinal study found that 16% of patients with
Treatment
The management of COPD in older adults is similar to that in the general adult population. The goals of therapy include controlling exposure to risk factors, symptom control, improvement of quality of life, limiting lung function decline, prevention of exacerbations, and decreasing mortality. Nevertheless, clinicians may be faced with unique challenges when treating elderly patients with COPD, including the following:
- 1.
The presence of comorbidities, such as glaucoma, cardiac disease, or
References (80)
- et al.
Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study
Chest
(1994) - et al.
Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years
Respir Med
(2005) - et al.
COPD as a disease of accelerated lung aging
Chest
(2009) - et al.
Spirometry and maximal respiratory pressure references from healthy Minnesota 65- to 85-year-old women and men
Chest
(1995) - et al.
Study of respiratory function in the elderly with different nutritional and cognitive status and functional ability assessed by plethysmographic and spirometric parameters
Arch Gerontol Geriatr
(2003) - et al.
International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study
Lancet
(2007) - et al.
COPD prevalence in Salzburg, Austria: results from the Burden of Obstructive Lung Disease (BOLD) Study
Chest
(2007) - et al.
Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking Report from the Obstructive Lung Disease in Northern Sweden Studies
Respir Med
(2006) - et al.
Burden of concomitant asthma and COPD in a Medicaid population
Chest
(2008) - et al.
The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom
Chest
(2003)
Mortality and markers of risk of asthma death among 1,075 outpatients with asthma
Chest
Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect
Environ Res
12-Year change in prevalence of respiratory symptoms in elderly Chinese living in Hong Kong
Respir Med
Asthma as a risk factor for COPD in a longitudinal study
Chest
Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study
Lancet
Characteristics of asthma among elderly adults in a sample of the general population
Chest
Asthma in older adults
Clin Chest Med
Impaired bronchodilator response to albuterol in healthy elderly men and women
Chest
Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines
Chest
Safety of long-acting beta-agonists in stable COPD: a systematic review
Chest
The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol
Chest
A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol
Chest
Cardiovascular safety of tiotropium in patients with COPD
Chest
The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials
Am J Med
Update on the management of COPD
Chest
Assessing the vitamin D status of the US population
Am J Clin Nutr
Relationship between serum 25-hydroxyvitamin D and pulmonary function in the Third National Health and Nutrition Examination Survey
Chest
The global burden of disease, 1990-2020
Nat Med
Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach
The WHO perspective on active ageing
Promot Educ
Prevalence of obstructive lung disease in a general population sample: the NICECOPD study
Eur J Epidemiol
Clinical relevance of airway remodelling in airway diseases
Eur Respir J
Interpretative strategies for lung function tests
Eur Respir J
Quality control of spirometry in the elderly. The SA.R.A. study. SAlute Respiration nell'Anziano = Respiratory Health in the Elderly
Am J Respir Crit Care Med
Quality of spirometric performance in older people
Age Ageing
Incidence of GOLD-defined chronic obstructive pulmonary disease in a general adult population
Int J Tuberc Lung Dis
Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study
Thorax
Environmental tobacco smoke exposure and asthma in adults
Environ Health Perspect
Asthma in older patients: factors associated with hospitalization
Arch Intern Med
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Disclosure of potential conflict of interest: D. M. Mannino receives research support from GlaxoSmithKline, Novartis, and AstraZeneca; has provided legal consultation/expert witness testimony in cases related to cigarette smoking and COPD; and is a board member of the COPD Foundation. E. Diaz-Guzman has declared that he has no conflict of interest.