Beiträge zum Themenschwerpunkt Z Gerontol Geriat 2014 DOI 10.1007/s00391-014-0645-6 © Springer-Verlag 2014
J. Schlitzer1 · S. Haubaum1 · H. Frohnhofen1, 2 1 Zentrum für Altersmedizin, Kliniken Essen Mitte 2 Department of Health, University Witten-Herdecke
Treatment of chronic obstructive pulmonary disease in hospitalized geriatric patients
Background Advancing age is strongly associated with an increased prevalence of chronic obstructive pulmonary disease (COPD) [1]. COPD is increasingly viewed as a chronic systemic disease that affects the body as a whole [17]. This increasing prevalence of COPD with advancing age is due to the concomitant impact of age-associated deterioration in pulmonary function and a lifelong exposure to accumulative risk factors, in particular inhaled cigarette smoking [2]. Furthermore, there is an overlap between chronic bronchitis, emphysema and asthma in the elderly, rendering differential diagnosis difficult [3, 4, 5]. The Burden of Obstructive Lung Disease (BOLD) study reported that the average prevalence of COPD reached 14% in subjects aged over 65 years [6]. For a man who has been asymptomatic up to the age of 54 years, the cumulative risk of developing COPD increases for each additional decade of his life, i.e. by 4, 10, 18 and 24% for the next four decades, respectively. For women, the corresponding values are 3, 8, 13 and 16% [7]. Furthermore, older patients with COPD are twice as likely to rate their health as fair or poor and twice as likely to report limitations in usual activities [8]. Therefore, COPD is a disabling and expensive disease. In addition, the estimated number of unreported cases of COPD in older individuals is high [9]. This is due to a very gradual onset of disease and the absence of dyspnea symptoms if exertion is not present. Furthermore, dyspnea is significantly less well perceived by older people,
possibly as an expression of the subjective age-equivalent due the association of reduced exercise with diseases like heart failure or COPD [10]. This may explain why COPD is underdiagnosed and undertreated in an elderly population [11]. Treatment of COPD primarily involves inhaled bronchodilators [3]. Inhaled drugs have the advantage of being organ-tropic, with minimum systemic side effects. Moreover, the required level of active agent is also significantly lower [3]. The primary intent of the study was to evaluate the pattern of pharmacotherapy prescription for COPD in patients admitted to a geriatric rehabilitation unit. The secondary intent was to examine whether there are any factors that might affect the prescription of pharmacotherapy for COPD in geriatric patients.
Methods This retrospective study analyzed dossiers of patients admitted to a geriatric unit for rehabilitation in 2008 and 2009. Patients were eligible if they had been in a stable health condition, had COPD and had undergone a successful lung function test by means of body plethysmography. Data on age, gender, comorbidities and geriatric assessment were collected. Geriatric assessment encompassed measurement of activities of daily living (ADLs) using the Barthel Index [12] and cognition by means of the Mini Mental State Examination (MMSE) [13]. The diagnosis of COPD was based upon a history of bronchial obstruction, any previous treatment for bronchial obstruc-
tion, a history of smoking or the Global Initiative of Chronic Lung Disease (GOLD) definition with a relative forced expiratory volume in 1 s (FEV1/forced vital capacity) below 70% [14]. The diagnosis had to be confirmed by a pneumologist. The severity of COPD was graded, according to the GOLD recommendations, as mild (FEV1 >80%), moderate (FEV1 50–80%), severe (FEV1 30–50%) or very severe (FEV1 80% N=45 82±5 23±13
FEV1 50–80% N=99 81±6 19±12
FEV1 30–50% N=70 79±7 23±13
FEV1
J. Schlitzer1 · S. Haubaum1 · H. Frohnhofen1, 2 1 Zentrum für Altersmedizin, Kliniken Essen Mitte 2 Department of Health, University Witten-Herdecke
Treatment of chronic obstructive pulmonary disease in hospitalized geriatric patients
Background Advancing age is strongly associated with an increased prevalence of chronic obstructive pulmonary disease (COPD) [1]. COPD is increasingly viewed as a chronic systemic disease that affects the body as a whole [17]. This increasing prevalence of COPD with advancing age is due to the concomitant impact of age-associated deterioration in pulmonary function and a lifelong exposure to accumulative risk factors, in particular inhaled cigarette smoking [2]. Furthermore, there is an overlap between chronic bronchitis, emphysema and asthma in the elderly, rendering differential diagnosis difficult [3, 4, 5]. The Burden of Obstructive Lung Disease (BOLD) study reported that the average prevalence of COPD reached 14% in subjects aged over 65 years [6]. For a man who has been asymptomatic up to the age of 54 years, the cumulative risk of developing COPD increases for each additional decade of his life, i.e. by 4, 10, 18 and 24% for the next four decades, respectively. For women, the corresponding values are 3, 8, 13 and 16% [7]. Furthermore, older patients with COPD are twice as likely to rate their health as fair or poor and twice as likely to report limitations in usual activities [8]. Therefore, COPD is a disabling and expensive disease. In addition, the estimated number of unreported cases of COPD in older individuals is high [9]. This is due to a very gradual onset of disease and the absence of dyspnea symptoms if exertion is not present. Furthermore, dyspnea is significantly less well perceived by older people,
possibly as an expression of the subjective age-equivalent due the association of reduced exercise with diseases like heart failure or COPD [10]. This may explain why COPD is underdiagnosed and undertreated in an elderly population [11]. Treatment of COPD primarily involves inhaled bronchodilators [3]. Inhaled drugs have the advantage of being organ-tropic, with minimum systemic side effects. Moreover, the required level of active agent is also significantly lower [3]. The primary intent of the study was to evaluate the pattern of pharmacotherapy prescription for COPD in patients admitted to a geriatric rehabilitation unit. The secondary intent was to examine whether there are any factors that might affect the prescription of pharmacotherapy for COPD in geriatric patients.
Methods This retrospective study analyzed dossiers of patients admitted to a geriatric unit for rehabilitation in 2008 and 2009. Patients were eligible if they had been in a stable health condition, had COPD and had undergone a successful lung function test by means of body plethysmography. Data on age, gender, comorbidities and geriatric assessment were collected. Geriatric assessment encompassed measurement of activities of daily living (ADLs) using the Barthel Index [12] and cognition by means of the Mini Mental State Examination (MMSE) [13]. The diagnosis of COPD was based upon a history of bronchial obstruction, any previous treatment for bronchial obstruc-
tion, a history of smoking or the Global Initiative of Chronic Lung Disease (GOLD) definition with a relative forced expiratory volume in 1 s (FEV1/forced vital capacity) below 70% [14]. The diagnosis had to be confirmed by a pneumologist. The severity of COPD was graded, according to the GOLD recommendations, as mild (FEV1 >80%), moderate (FEV1 50–80%), severe (FEV1 30–50%) or very severe (FEV1 80% N=45 82±5 23±13
FEV1 50–80% N=99 81±6 19±12
FEV1 30–50% N=70 79±7 23±13
FEV1
