Division of Geriatric Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2010 Jun;58(6):1153-62. doi: 10.1111/j.1532-5415.2010.02875.x.
Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short-and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients.
慢性阻塞性肺疾病（COPD）在老年人中是一种复杂的疾病，具有几个独特的与年龄相关的方面。随着年龄的增长，肺部功能的潜在变化以及对支气管收缩和缺氧的敏感性降低，可能使老年人面临更大的死亡风险或其他 COPD 并发症的风险。全球阻塞性肺病倡议标准的建立，可以有效地应用于老年人，更严格地定义了 COPD 的诊断和管理。该方法的一个重要组成部分是使用肺活量计进行疾病分期，大多数老年人都可以进行该程序。COPD 的管理包括戒烟、流感和肺炎球菌疫苗接种，以及使用短效和长效支气管扩张剂。与哮喘不同，皮质类固醇吸入剂是 COPD 的三线治疗选择。通常需要联合治疗。在使用各种吸入器设计时，需要注意的是，老年人，尤其是那些病情更严重的老年人，可能由于某些干粉吸入器的吸气力不足，尽管许多老年人发现干粉吸入器比计量吸入器更容易使用。其他重要的治疗选择包括肺康复、氧疗、无创正压通气以及抑郁和骨质疏松筛查。照顾急性 COPD 加重的老年人的临床医生也应该防止预后悲观。虽然 COPD 与显著的残疾有关，但有越来越多的治疗选择可以帮助患者。
