Hidden realities of COPD among the very old

“…Besides spirometry, COPD diagnosis requires assessment of respiratory symptoms, risk factors and comorbidities [2,4], as even similar degrees of airflow limitation have different effects on symptoms, comorbidities and outcomes [25,26]. In very old adults, COPD diagnosis becomes even more complex, as respiratory symptoms such as dyspnoea may be assigned to ageing and common comorbidities such as heart failure [27]. Thus, a comprehensive diagnostic approach, which recognises the heterogeneity and clinical phenotypes of COPD and includes spirometry, needs to be applied [2,3,25,26].…”

Section: Discussionmentioning

confidence: 99%

Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults

et al. 2015

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The cut-off for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) defining airflow limitation for chronic obstructive pulmonary disease (COPD) is still contested. We assessed airflow limitation prevalence by the lower limit of normal (LLN) of Global Lungs Initiative (GLI) 2012 reference values and its predictive ability for all-cause mortality and hospitalisation in very old adults (aged ⩾80 years) compared with the fixed cut-off.In a Belgian population-based prospective cohort of 411 very old adults, airflow limitation prevalence by the 5th percentile of GLI 2012 z-scores (GLI-LLN) and fixed cut-off (0.70) were compared with COPD reported by general practitioners (GPs). Survival and Cox regression multivariable analysis assessed the association of airflow limitation by both cut-offs with 5-year all-cause mortality and first hospitalisation at 3 years.9.2% had airflow limitation by GLI-LLN and 27% by fixed cut-off, without good agreement (kappa coefficient ⩽0.40) with GP-reported COPD (9%). Only airflow limitation by GLI-LLN was independently associated with mortality (adjusted hazard ratio 2.10, 95% CI 1.30-3.38). FEV1/FVC <0.70 but ⩾GLI-LLN (17.8%) had no significantly higher risk for mortality or hospitalisation.In a cohort of very old adults, airflow limitation by GLI-LLN has lower prevalence than by fixed cut-off, independently predicts all-cause mortality and does not miss individuals with significantly higher all-cause mortality and hospitalisation. Support statement: The BELFRAIL study (B40320084685) was supported by an unconditional grant from Fondation Louvain, Brussels, Belgium. Fondation Louvain is the support unit of Université Catholique de Louvain and is charged with developing the educational and research projects of the university by collecting gifts from corporations, foundations and alumni. Funding information for this article has been deposited with FundRef.

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“…Other factors, such as indoor and outdoor air pollution, infection in childhood, asthma, genetic factors [ 1 , 9 ] and occupational dust have been reported to contribute to the development of COPD [ 10 ]. COPD is associated with an increased mortality and morbidity implications such as lung cancer, anemia [ 10 ], pulmonary hypertension, polycythaemia, peripheral oedema, cardiovascular complications, obstructive sleep apnea, chronic infections, and musculoskeletal disorders (e.g., osteopenia and muscle atrophy) [ 1 , 19 ] as well as nutritional depletion that is caused by increased metabolism during breathiness episodes [ 11 , 13 ]. Patients with COPD are significantly more likely to report symptoms such as insomnia and difficulty in initiating and maintaining sleep [ 20 ].…”

Section: Chronic Obstructive Pulmonary Disease (Copd)mentioning

confidence: 99%

Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature

2014

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Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.

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Hidden realities of COPD among the very old

Cited by 4 publications

References 0 publications

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Airflow limitation by the Global Lungs Initiative equations in a cohort of very old adults

Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature

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