Inhalation treatment of chronic obstructive pulmonary disease (COPD) in older patients

Chronic obstructive pulmonary disease (COPD) is frequent in older patients. Frailty, cognitive impairment and sarcopenia are predictors for inadequately performed lung function testing as well as presenting challenges in subsequent disease management. Underdiagnosis and suboptimal treatment are often the result of incomplete assessment of older COPD patients. Problems associated with older COPD patients are not adequately addressed in international guidelines, although numerous evidence-based strategies are available. A key aspect is the management of the various inhaler devices. Up to 60-80% of older patients with COPD do not use the inhalers correctly. Even when the inhaler technique is correct, there is undertreatment if the required inspiratory flow cannot be achieved. Given the high rate of suboptimal inhaler treatment in older patients with COPD, an analysis of the pitfalls is important. An objective measurement of inspiratory flow and assessment of cognition and coordination are essential. A possible clinical algorithm for the assessment of older patients with respect to inhaler treatment of COPD is presented in a consensus approach by the Pneumological Geriatric Medicine Working Group of the German Society of Pulmonologists.