COPD in the Elderly

A Reversible Cause of Functional Impairment

¹ From Northwestern University Medical School, Chicago
² From the Division of Geriatrics, Chicago
³ From the Division of Pulmonary Medicine, Chicago
⁴ From Northwestern University Medical School, and the Buehler Center on Aging, McGaw Medical Center, Northwestern University, Chicago

Objectives: To determine the frequency of referral of patients age 69 years and older to the pulmonary function laboratory at a tertiary-care hospital for airflow limitation studies; to determine the point prevalence of a significant reversible component in patients with COPD as an age-related function; and to determine the proportion of patients who were prescribed bronchodilators following a pulmonary function test (PFT) demonstrating significant reversibility.

Design: A retrospective review of pulmonary function tests of patients 69 years and older within calendar year 1990 was performed. Chart review of those showing significant reversibility to bronchodilators during a PFT was performed to determine level of follow-up.

Setting: Referral-based pulmonary division in a tertiary-care hospital.

Patients: Men and women 69 years and older who had interpretable PFTs at Northwestern Memorial Hospital (NMH) during the calendar year 1990 (n=405). Patients whose PFTs were uninterpretable due to poor effort (n=10) were excluded from the study.

Interventions: No specific interventions were performed as a part of the study. Referring physicians may have requested a PFT with postbronchodilator (albuterol by nebulizer) testing and may have subsequently prescribed bronchodilators for their patients.

Measurements: We studied the effect of age, gender, smoking history, and degree of airflow obstruction on changes in spirometry values and reversibility status after bronchodilator (if applicable) as determined by a PFT.

Main results: Of the 405 consecutive elderly patients studied, 193 (47.7%) received bronchodilators and 60 (31.1%) of these patients had significant improvement as judged by the criteria listed in the Methods section. The improvement occurred equally across all age groups (p>0.05) and the percent responding to bronchodilators increased as the degree of obstruction increased (p<0.001). Those who had never smoked were twice as likely to respond than were current or former smokers; men were more likely to respond than women. Most patients (84%) who responded were subsequently prescribed bronchodilators.

Conclusions: Responses to inhaled bronchodilators occur at all ages. Older patients showed greater reversibility as the degree of obstruction increased, while a smoking history reduced the likelihood of a bronchodilator response. COPD in the elderly may differ from the traditional form of the disease.

Key Words: albuterol • bronchodilator agents • COPD • respiratory function tests

Submitted on September 2, 1994
Accepted on March 22, 1995

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