Department of Respiratory Physiology, Catholic University, Rome, Italy.
Curr Opin Pulm Med. 2011 Dec;17 Suppl 1:S43-8. doi: 10.1097/01.mcp.0000410747.20958.39.
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease.
In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations.
The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines.
慢性阻塞性肺疾病（COPD）是全球范围内老年人最常见且日益严重的健康问题之一。本综述参考 COPD 稳定期，讨论了老年患者 COPD 管理中的实际诊断和治疗问题。
在老年 COPD 的诊断方法中，建议使用肺量计，但应考虑患者的具体情况（如因疲劳、协调能力差和认知障碍而无法正确进行检查）和测试指标的特点。人群研究表明，固定比值的使用会导致对最年长患者 COPD 的过度诊断。已经提出了其他参数[例如评估 FEV1/FVC 比值的正常值下限（LLN）]，这可能有助于指导诊断。已经证明，一些非药物干预措施（如戒烟、疫苗接种、身体活动和肺康复、营养，以及最终的有创通气）和药物干预措施可以改善结局，我们对此进行了综述。老年 COPD 的有效管理应始终考虑患者正确使用吸入器的能力，并让照护者或家庭成员参与其中，作为照护的有用支持，尤其是在治疗认知障碍患者时。在老年人群中，及时识别和治疗合并症也至关重要，但这方面的证据仍然缺乏，临床实践指南在其建议中也没有考虑到合并症。
全球阻塞性肺病倡议为一般人群的 COPD 诊断和管理推荐了标准。相反，现有证据表明，在稳定期 COPD 的老年患者中，诊断方法和干预策略存在实际限制，需要进一步研究，以便将其转化为临床实践指南。
