Treating COPD in Older and Oldest Old Patients

Abstract

The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting betaagonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive functions and sleep. Nonpharmacological interventions, including education, physical exercise, nutritional support, pulmonary rehabilitation and telemonitoring can importantly contribute to improve outcomes. Older patients with COPD should be systematically evaluated for the presence of risk factors for non-adherence, and the inhaler device should be chosen very carefully. Comorbidities, such as cardiovascular diseases, chronic kidney disease, osteoporosis, obesity, cognitive, visual and auditory impairment, may significantly affect treatment choices and should be scrutinized. Palliative care is of paramount importance in end-stage COPD. Finally, treatment of COPD exacerbations has been also reviewed. Therapeutic decisions should be founded on a careful assessment of cognitive and functional status, comorbidity, polypharmacy, and agerelated changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions, and non-adherence to treatment.

Rehabilitation in Palliative Care

“…[35][36][37] It can also promote the reduction of stress and positively influence the patient's perceived independence. 22 Effects of rehabilitation related to the psychosocial sphere, such as anxiety, stress and depression, were also found, as well as the patients' desire to feel physically better, even when they know that death is approaching.…”

Wearable sensors: can they benefit patients with chronic kidney disease?

“…reduced estimated glomerular filtration rate despite normal serum creatinine) and overt (i.e. reduced estimated glomerular filtration rate with increased serum creatinine) CKD in older patients with COPD have been reported to be 20.8% and 22.2%, respectively [4].…”

“…In COPD patients, both physical inactivity due to exercise intolerance and systemic inflammation may explain prevalent loss of fat-free mass. Hypoxia-driven expansion of extracellular and intracellular water (ICW) volumes may explain why malnutrition can occur despite normal weight [4]. CKD patients with heart failure are extremely fragile: They may develop cardiac decompensation or renal failure from what otherwise would be harmless changes in body fluid status, altered medication, or intercurrent illness [25].…”

“…PA programs, on both group-and personal level, are often difficult to implement in this patient group due to high costs and lack of motivation. On top of that, in its early stages, CKD can remain concealed because of sarcopenia, via misleading low serum creatinine due to sarcopenia-induced decreased creatinine release [4].…”

Research on the Role of Matrix Metalloproteinase in the Patients with Stable Phase COPD Accompanied by Osteoporosis

“…TIMPs are also multifunctional molecules capable of inhibiting the activity of MMPs and playing a role similar to cell growth factors. They can promote the growth of proliferation fibroblasts and collagen synthesis, deposit ECM, and inhibit its degradation [10].…”