Epidemiological aspects and early detection of chronic obstructive airway diseases in the elderly

Abstract

The burdens of chronic obstructive airway diseases among the elderly in Europe, and worldwide, are increasing. Although asthma is common in all ages, the main airway disease affecting the elderly is chronic obstructive pulmonary disease (COPD). The aim of this paper is to review the prevalence and incidence of COPD on the basis of population studies. As the prevalence estimates of asthma are probably well known, only the incidence and remission of asthma will be discussed. The underdiagnosis of obstructive airway diseases is huge. A Dutch programme for early detection of obstructive airway disease among the elderly has, thus, been included in the presentation.A prerequisite for fighting COPD is to acquire data on illnesses and death. COPD has only recently been defined by cut-off points of spirometric outcomes, which is why measures of the prevalence of COPD have been distorted by use of a large number of different diagnostic terms and lung function criteria. The prevalence of clinicallyrelevant COPD has been estimated in several community studies to 4-6% in adult population samples, with a considerable increase by age, particularly among smokers. The incidence of COPD not only increases heavily with age and smoking, but also occupational exposure to dust, gas and damp. Precise estimates of the incidence of COPD or spirometric airflow limitation are not available.Demographic changes will result in a further substantial increase of chronic obstructive airway disorders, mainly chronic obstructive pulmonary disease, among the elderly. The increasing burden of chronic obstructive pulmonary disease has to come to the awareness of the public, governments, health authorities, and industry. Eur Respir J 2003; 21: Suppl. 40, 3s-9s.

Predictors of Hospital Admission for Chronic Obstructive Pulmonary Disease Exacerbations in Canadian Emergency Departments

“…Moreover, patients who were diagnosed with COPD for the first time during their ED visit were more likely to be discharged, which led us to think that an early diagnosis reflects a lower severity of illness and perhaps more reserve to compensate for the exacerbation. [26][27][28] In other studies, three or more hospitalizations in the previous year have been identified as a risk factor for admission. 10,29 Our results show that having two or more admissions for COPD in the past 2 years predicts the risk of admission.…”

Screening for Suspected Chronic Obstructive Pulmonary Disease with an Eleven-Item Pre-Interview Questionnaire (11-Q)

“…Despite the rigid differential diagnosis between COPD and bronchial asthma by various clinical examinations, it might be difficult to distinguish COPD from early onset asthma (1)(2)(3)20), although previous studies encountered similar problems (21)(22)(23). In particular, it is occasionally difficult to distinguish early onset bronchial asthma from COPD in elderly patients (20) (20).…”

COPD prevalence and the differences between newly and previously diagnosed COPD patients in a spirometry program

“…1 Several authors have recommended the use of the lower limit of normal (LLN), 45,46 since the FEV1/FVC ratio decreases with increasing age and thus the use of a fixed ratio may lead to misclassification. 47 However, Mannino et al have shown that the use of the 0.7 fixed ratio can identify patients at increased risk of death or hospitalisation, even among older adults. 48 Based on the aforementioned studies and the fact that we wanted our results to be more easily applicable in clinical practice, we chose to use the fixed ratio of 0.70 for the diagnosis of COPD.…”