[Respiratory medicine in the aged. Therapeutic problemsd]

Chronic obstructive pulmonary disease (COPD) is very common in the elderly, and its treatment needs special concern. Data from two clinical studies (in-patients of an Internal Medicine Department and Nursing-Home, respectively) have been evaluated in order to compare therapeutic approaches to COPD in three separate settings: home, hospital and Nursing-Home. Less than 50% of the overall patients received medical treatment according to the guidelines emerged in the literature. Although cardiovascular problems were highly common in out-patients, their bronchodilator therapy included systemic beta 2-agonists. Theophylline was the main drug prescribed to in-patients discharged from hospital, although inhaling beta 2-agonists were also recommended in few cases. Topical steroids have been widely used. Nursing-Home patients received mostly systemic steroids and few of them had theophylline and inhaling steroids. Anti-cholinergic drugs have never been employed in the overall population of elderly patients. Data concerning medical treatment of infectious respiratory diseases of Nursing-Home patients (both with and without COPD) have also been evaluated. Antimicrobial therapy has been performed according to the special needs of the elderly. During COPD reacutizations, beta 2-agonists and, again, theophylline consumption increased.