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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Practical management problems of stable chronic obstructive pulmonary disease in the elderly
Riccardo Pistelli1, Letizia Ferrara, Clementina Misuraca
1Department of Respiratory Physiology, Catholic University, Rome, Italy.
Current Opinion in Pulmonary Medicine
|January 3, 2012
Summary
Managing chronic obstructive pulmonary disease (COPD) in the elderly requires careful spirometry interpretation and consideration of patient factors. Effective strategies involve non-pharmacologic interventions and caregiver support, but guidelines need updating for this population.
Area of Science:
- Gerontology
- Pulmonology
- Internal Medicine
Background:
- Chronic obstructive pulmonary disease (COPD) is a growing global health concern, particularly among the elderly.
- Managing COPD in older adults presents unique diagnostic and treatment challenges.
Purpose of the Study:
- To review diagnostic and treatment issues for stable COPD in the elderly.
- To highlight practical limitations in current COPD management guidelines for older patients.
Main Methods:
- Review of diagnostic approaches, including spirometry and alternative parameters like Lower Limit of Normality (LLN).
- Evaluation of non-pharmacologic interventions (smoking cessation, vaccination, physical activity, pulmonary rehabilitation, nutrition, ventilation) and pharmacologic treatments.
- Consideration of patient-specific factors like inhaler use, cognitive impairment, and caregiver involvement.
- Emphasis on timely identification and treatment of comorbidities.
Main Results:
- Spirometry in the elderly requires accounting for patient conditions and metric characteristics; fixed ratios may lead to overdiagnosis.
- LLN for FEV1/FVC ratio is a potential diagnostic aid.
- Non-pharmacologic and pharmacologic interventions can improve outcomes in older adults with COPD.
- Patient ability to use inhalers and caregiver involvement are critical for effective management.
- Comorbidity management is crucial but lacks sufficient evidence and guideline integration.
Conclusions:
- Current Global Initiative for Obstructive Lung Disease guidelines may not fully address the complexities of COPD diagnosis and management in older adults.
- Further research is needed to refine diagnostic criteria and interventions for stable COPD in the elderly to inform clinical practice guidelines.
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