Reviews and feature article
Airway obstructive diseases in older adults: From detection to treatment

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Asthma and chronic obstructive pulmonary disease occur commonly and may overlap among older adults. Smoking, air pollution, and bronchial hyperresponsiveness are the main risk factors. The treatment of these diseases in older adults does not differ from the available guidelines but may be complicated by the presence of comorbidities. Smoking cessation is essential for smokers, and pulmonary rehabilitation must be considered regardless of the age of the patient.

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

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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.

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