[COPD in elderly patients]

The lifetime risk of developing COPD is estimated to be between 25 and 30% (10% risk for COPD stage II or worse). It is projected that COPD will become the third leading cause of death within the next decade. COPD may be understood as a disease of accelerated lung ageing: The accumulation of senescent cells in the lungs results in the loss of repair ability and the release of inflammatory mediators. Geriatric patients typically present with multimorbidity, polypharmacy, restrictions in daily life, frailty and sarcopenia. Up to two-thirds of elderly patients with COPD have dysphagia, which leads to aspiration in 40% of cases and is prognostically unfavourable. Older patients with COPD are less likely to experience breathlessness than younger patients. In old patients with COPD, spirometry is the most important lung function test. FEV₆ instead of the FVC may be used. The clock test, mini-cog and the ability to draw two pentagons on top of each other are the best ways to screen patients with dementia to determine whether spirometry is feasible. Impulse oscillometry is a well investigated lung function test for elderly patients with COPD with the advantage not to require special cooperation. The 1-minute walking test or the 1-minute sit-to-stand test are good geriatric alternatives for the 6-minute walking test. The treatment is based on the current COPD guidelines. Substances with a long duration of action, such as fluticasone furoate, vilanterol and umeclidinium, are the best option. The capillary PO₂ is 6 mmHg higher than the arterial PO₂. The difference is even greater in heart failure. The ventilation-perfusion distribution disorder also increases with age, particularly when lying down. This is due to the increase in occlusion capacity, which causes the small airways to collapse earlier. It is essential to consider comorbidities and body position during blood gas sampling to avoid an oversupply of home oxygen therapy in old age.