COPD in the elderly. A reversible cause of functional impairment

To determine the frequency of referral of patients age 69 years and older to the pulmonary function laboratory at a tertiary-care hospital for airflow limitation studies; to determine the point prevalence of a significant reversible component in patients with COPD as an age-related function; and to determine the proportion of patients who were prescribed bronchodilators following a pulmonary function test (PFT) demonstrating significant reversibility.

A retrospective review of pulmonary function tests of patients 69 years and older within calendar year 1990 was performed. Chart review of those showing significant reversibility to bronchodilators during a PFT was performed to determine level of follow-up.

Referral-based pulmonary division in a tertiary-care hospital.

Men and women 69 years and older who had interpretable PFTs at Northwestern Memorial Hospital (NMH) during the calendar year 1990 (n = 405). Patients whose PFTs were uninterpretable due to poor effort (n = 10) were excluded from the study.

No specific interventions were performed as a part of the study. Referring physicians may have requested a PFT with postbronchodilator (albuterol by nebulizer) testing and may have subsequently prescribed bronchodilators for their patients.

We studied the effect of age, gender, smoking history, and degree of airflow obstruction on changes in spirometry values and reversibility status after bronchodilator (if applicable) as determined by a PFT.

Of the 405 consecutive elderly patients studied, 193 (47.7%) received bronchodilators and 60 (31.1%) of these patients had significant improvement as judged by the criteria listed in the Methods section. The improvement occurred equally across all age groups (p > 0.05) and the percent responding to bronchodilators increased as the degree of obstruction increased (p < 0.001). Those who had never smoked were twice as likely to respond than were current or former smokers; men were more likely to respond than women. Most patients (84%) who responded were subsequently prescribed bronchodilators.

Responses to inhaled bronchodilators occur at all ages. Older patients showed greater reversibility as the degree of obstruction increased, while a smoking history reduced the likelihood of a bronchodilator response. COPD in the elderly may differ from the traditional form of the disease.