Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 4/2014

01.06.2014 | Beiträge zum Themenschwerpunkt

Treatment of chronic obstructive pulmonary disease in hospitalized geriatric patients

verfasst von: J. Schlitzer, MD, S. Haubaum, MD, H. Frohnhofen, MD

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Chronic obstructive pulmonary disease (COPD) is frequent in older subjects due to deterioration of pulmonary function and lifelong exposure to risk factors. Furthermore, COPD is often underreported because of the gradual onset of symptoms and reduced perception of symptoms in the elderly. There is thus a risk of undertreatment of COPD in older subjects.

Methods

We retrospectively analyzed dossiers of 229 hospitalized geriatric patients with COPD, complete assessment datasets and successful lung function tests.

Results

The sample comprised 78 men (38 %; mean age 77 ± 7 years) and 151 women (66 %; mean age 81 ± 6 years). The number of untreated patients decreased from 68 (28 %) at admission to 35 (14 %) at discharge (p < 0.01). Absence of treatment was associated with severity of disease: mild COPD was less likely to be treated. During the hospital stay, the prescription of metered dose inhalers (MDIs) decreased and the prescription of nebulizers increased, most likely due to the coordination problems associated with using inhalers.

Conclusion

Undertreatment of COPD is frequent among hospitalized geriatric patients. There is a need for adaption of current guidelines to the needs of older patients with frailty or cognitive impairment.
Literatur
2.
Zurück zum Zitat Mannino DM, Sonia Buist A, Vollmer WM (2007) Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function? Thorax 62:237–241CrossRefPubMedCentralPubMed Mannino DM, Sonia Buist A, Vollmer WM (2007) Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function? Thorax 62:237–241CrossRefPubMedCentralPubMed
3.
Zurück zum Zitat Diaz-Guzman E, Mannino DM (2010) Airway obstructive diseases in older adults: from detection to treatment. J Allergy Clin Immunol 126:702–709CrossRefPubMed Diaz-Guzman E, Mannino DM (2010) Airway obstructive diseases in older adults: from detection to treatment. J Allergy Clin Immunol 126:702–709CrossRefPubMed
4.
5.
Zurück zum Zitat Nakawah MO, Hawkins C, Barbandi F (2013) Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome. J Am Board Fam Med 26:470–477CrossRefPubMed Nakawah MO, Hawkins C, Barbandi F (2013) Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome. J Am Board Fam Med 26:470–477CrossRefPubMed
6.
Zurück zum Zitat Buist AS, McBurnie MA, Vollmer WM et al (2007) International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 370:741–750CrossRefPubMed Buist AS, McBurnie MA, Vollmer WM et al (2007) International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 370:741–750CrossRefPubMed
7.
Zurück zum Zitat Durme YMTA van, Verhamme KMC, Stijnen T et al (2009) Prevalence, incidence, and lifetime risk for the development of COPD in the elderly: the Rotterdam study. Chest 135:368–377CrossRefPubMed Durme YMTA van, Verhamme KMC, Stijnen T et al (2009) Prevalence, incidence, and lifetime risk for the development of COPD in the elderly: the Rotterdam study. Chest 135:368–377CrossRefPubMed
8.
Zurück zum Zitat Cydulka RK, McFadden ER, Emerman CL et al (1997) Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 156:1807–1812CrossRefPubMed Cydulka RK, McFadden ER, Emerman CL et al (1997) Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 156:1807–1812CrossRefPubMed
9.
Zurück zum Zitat Halbert RJ, Natoli JL, Gano A et al (2006) Global burden of COPD: systematic review and meta-analysis. Eur Respir J 28:523–532CrossRefPubMed Halbert RJ, Natoli JL, Gano A et al (2006) Global burden of COPD: systematic review and meta-analysis. Eur Respir J 28:523–532CrossRefPubMed
10.
Zurück zum Zitat Hardie JA, Vollmer WM, Buist AS et al (2005) Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years. Respir Med 99:186–195CrossRefPubMed Hardie JA, Vollmer WM, Buist AS et al (2005) Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years. Respir Med 99:186–195CrossRefPubMed
11.
Zurück zum Zitat Hardie JA, Buist AS, Vollmer WM et al (2002) Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 20:1117–1122CrossRefPubMed Hardie JA, Buist AS, Vollmer WM et al (2002) Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 20:1117–1122CrossRefPubMed
12.
Zurück zum Zitat Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65PubMed Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65PubMed
13.
Zurück zum Zitat Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMed
14.
Zurück zum Zitat Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (2011) http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013 Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (2011) http://​www.​goldcopd.​org/​uploads/​users/​files/​GOLD_​Report_​2013
15.
Zurück zum Zitat Mahler DA, Faryniarz K, Tomlinson D et al (1992) Impact of dyspnea and physiologic function on general health status in patients with chronic obstructive pulmonary disease. Chest 102:395–401CrossRefPubMed Mahler DA, Faryniarz K, Tomlinson D et al (1992) Impact of dyspnea and physiologic function on general health status in patients with chronic obstructive pulmonary disease. Chest 102:395–401CrossRefPubMed
16.
Zurück zum Zitat Maio S, Baldacci S, Martini F et al (2014) COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners. Curr Med Res Opin (Epub ahead of print) Maio S, Baldacci S, Martini F et al (2014) COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners. Curr Med Res Opin (Epub ahead of print)
17.
Zurück zum Zitat Barnes PJ (2007) Chronic obstructive pulmonary disease: a growing but neglected global epidemic. PLoS Med. doi:10.1371/journal.pmed.0040112 Barnes PJ (2007) Chronic obstructive pulmonary disease: a growing but neglected global epidemic. PLoS Med. doi:10.1371/journal.pmed.0040112
18.
Zurück zum Zitat Allen SC, Prior A (1986) What determines whether an elderly patient can use a metered dose inhaler correctly? Br J Dis Chest 80:45–49CrossRefPubMed Allen SC, Prior A (1986) What determines whether an elderly patient can use a metered dose inhaler correctly? Br J Dis Chest 80:45–49CrossRefPubMed
19.
Zurück zum Zitat Dolovich M, Ruffin RE, Roberts R, Newhouse MT (1981) Optimal delivery of aerosols from metered dose inhalers. Chest 80:911–915PubMed Dolovich M, Ruffin RE, Roberts R, Newhouse MT (1981) Optimal delivery of aerosols from metered dose inhalers. Chest 80:911–915PubMed
20.
Zurück zum Zitat Frohnhofen H, Hagen O (2011) Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD. Z Gerontol Geriatr 44:245–249CrossRefPubMed Frohnhofen H, Hagen O (2011) Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD. Z Gerontol Geriatr 44:245–249CrossRefPubMed
21.
Zurück zum Zitat Frohnhofen H, Heuer HC, Willschrei HP, Falkenhahn C (2011) Dementia among older in-hospital patients with obstructive airway disease: frequency and consequences. Z Gerontol Geriatr 44:240–244CrossRefPubMed Frohnhofen H, Heuer HC, Willschrei HP, Falkenhahn C (2011) Dementia among older in-hospital patients with obstructive airway disease: frequency and consequences. Z Gerontol Geriatr 44:240–244CrossRefPubMed
22.
Zurück zum Zitat Diggory P, Fernandez C, Humphrey A et al (2001) Comparison of elderly people’s technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial. BMJ 322:577–579CrossRefPubMedCentralPubMed Diggory P, Fernandez C, Humphrey A et al (2001) Comparison of elderly people’s technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial. BMJ 322:577–579CrossRefPubMedCentralPubMed
23.
Zurück zum Zitat Barr RG, Rowe BH, Camargo CA (2003) Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomised trials. BMJ. doi:10.1136/bmj.327.7416.643 Barr RG, Rowe BH, Camargo CA (2003) Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomised trials. BMJ. doi:10.1136/bmj.327.7416.643
24.
Zurück zum Zitat Stewart MF, Barclay J, Warburton R (1984) Risk of giving intravenous aminophylline to acutely ill patients receiving maintenance treatment with theophylline. Br Med J 288:450CrossRef Stewart MF, Barclay J, Warburton R (1984) Risk of giving intravenous aminophylline to acutely ill patients receiving maintenance treatment with theophylline. Br Med J 288:450CrossRef
25.
Zurück zum Zitat Upton RA (1991) Pharmacokinetic interactions between theophylline and other medication (Part I). Clin Pharmacokinet 20:66–80CrossRefPubMed Upton RA (1991) Pharmacokinetic interactions between theophylline and other medication (Part I). Clin Pharmacokinet 20:66–80CrossRefPubMed
26.
Zurück zum Zitat Barnes N, Calverley PMA, Kaplan A, Rabe KF (2013) Chronic obstructive pulmonary disease and exacerbations: clinician insights from the global Hidden Depths of COPD survey. BMC Pulm Med. doi:10.1186/1471-2466-13-54 Barnes N, Calverley PMA, Kaplan A, Rabe KF (2013) Chronic obstructive pulmonary disease and exacerbations: clinician insights from the global Hidden Depths of COPD survey. BMC Pulm Med. doi:10.1186/1471-2466-13-54
27.
Zurück zum Zitat Kirkham PA, Whiteman M, Winyard PG et al (2014) Impact of theophylline/corticosteroid combination therapy on sputum hydrogen sulfide levels in patients with COPD. Eur Respir J (Epub ahead of print) Kirkham PA, Whiteman M, Winyard PG et al (2014) Impact of theophylline/corticosteroid combination therapy on sputum hydrogen sulfide levels in patients with COPD. Eur Respir J (Epub ahead of print)
28.
Zurück zum Zitat Newton R (2014) Anti-inflammatory glucocorticoids: changing concepts. Eur J Pharmacol 724:231–236CrossRefPubMed Newton R (2014) Anti-inflammatory glucocorticoids: changing concepts. Eur J Pharmacol 724:231–236CrossRefPubMed
Metadaten
Titel
Treatment of chronic obstructive pulmonary disease in hospitalized geriatric patients
verfasst von
J. Schlitzer, MD
S. Haubaum, MD
H. Frohnhofen, MD
Publikationsdatum
01.06.2014
Verlag
Steinkopff-Verlag
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 4/2014
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-014-0645-6

Weitere Artikel der Ausgabe 4/2014

Zeitschrift für Gerontologie und Geriatrie 4/2014 Zur Ausgabe

CME Zertifizierte Fortbildung

Beginnende Demenz und Fahreignung

Journal Club

Journal Club