Orvoen-Frija E, Benoit M, Catto M, Chambouleyron M, Duguet A, Emeriau J-P, Ferry M, Hayot M, Jeandel C, Morize V, Nassih K, Ouksel H, Piette F, Prefaut C, Roche N, de Wazieres B, Zureik M
Service de physiologie, hôpital de la Pitié-Salpêtrière, CHU, 47-83, boulevard de l'Hôpital, 75181 Paris cedex 3, France.
Rev Mal Respir. 2010 Oct;27(8):855-73. doi: 10.1016/j.rmr.2010.08.005.
Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.
慢性阻塞性肺疾病（COPD）是一种以气流受限不完全可逆为特征的慢性疾病，通过FEV(1)/FVC比值下降来衡量。国际上对于该比值用于定义气流受限的单一阈值尚未达成共识。尽管根据所采用的定义，老年人群中COPD的患病率有所不同，但它肯定会随着年龄增长而增加，在65岁以上人群中可能达到15%。因此，未来几年人口老龄化将导致COPD的患病率和社会经济成本上升。在法国，老年COPD患者的诊断困难、延迟且不充分。其管理目标与年轻人群相同，必须全面且协调。鉴于一方面与COPD相关、另一方面与老龄化相关的累积风险，需要特别关注一些要点：药物副作用、身体和社会自主能力下降、营养受损、合并症。鉴于老年人群缺乏具体数据，药物治疗指征通常被认为与年轻人群相同，但需要采取一些额外的预防措施。肺康复在任何年龄似乎都有益处。姑息治疗面临重大困难：COPD姑息阶段开始时间不确定；姑息治疗资源不足；沟通不足；姑息治疗资源利用不足。老年COPD的全面管理需要协调，在涉及医疗和/或社会专业人员的医疗保健网络组织中能最好地实现这一点。
