Obstructive Lung Diseases
The major forms of obstructive lung disease are bronchial asthma and chronic obstructive pulmonary disease (COPD). Asthma is characterized by a predominantly functional bronchial obstruction that is almost entirely reversible, at least at early stages; CO
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Relevance for Elderly Patients, Epidemiology The major forms of obstructive lung disease are bronchial asthma and chronic obstructive pulmonary disease (COPD). Asthma is characterized by a predominantly functional bronchial obstruction that is almost entirely reversible, at least at early stages; COPD exposes structural changes and deficits of the respiratory tract, including the lung tissue, that are mostly irreversible. COPD is the typical and most prevalent chronic lung disease of the elderly, while new asthma will rarely occur, and existing asthma usually becomes milder at higher age. Therefore, the focus of this chapter is drug treatment of COPD in the elderly. Unfortunately, the epidemiological significance of COPD is not adequately recognized even today. Yet, the incidence will sharply rise in the future, and it is assumed that in 2030 COPD will be the thirdmost-important cause of death globally, only secondary to cardiovascular diseases and AIDS (Table 1). This epidemic reflects the aging of Western societies as COPD is an age-related disease and the lack of success against the main avoidable culprit, which is smoking, causing about 80–90% of all COPD-related deaths. Although in the United States smoking is on the
M. Wehling (*) University of Heidelberg, Maybachstr. 14, Mannheim 68169, Germany e-mail: [email protected]
decline, the increasing prevalence of smoking in women partly compensates for the success of smoking cessation. It is assumed that in 2008 there will be 12 million U.S. citizens who suffer from COPD (American Lung Association 2010), with an estimated equal number of undiagnosed cases. The prevalence of COPD in elderly U.S. citizens aged 65+ years was around 10 % in 2000 (Mannino et al. 2002) and should have risen in between. In patients aged 70+ years in Salzburg, Austria, the prevalence was at 50 % (Schirnhofer et al. 2007). Unfortunately, medical care, academic representation, and scientific efforts are not nearly adequate to properly address this tremendous challenge of industrial, wealthy societies, not to speak of developing or underdeveloped countries. This fact is even more relevant for COPD in the elderly, whose specific problems of multimorbidity, frailty, and polypharmacy add another dimension to the challenge. The indisputable successes of drug support for smoking cessation have been described in chapter “Coronary Heart Disease and Stroke” under the section “Therapeutically Relevant Special Features of Elderly Patients,” and nonpharmacological treatment combined with drugs represents a valuable opportunity for many patients, including the elderly. Smoking cessation is never too late; symptoms of COPD may improve at any stage of the disease, although the structural changes are irreversible. Reducing progression of COPD by smoking cessation is proven and should be utilized at any stage. Inborn diseases
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_11, # Springer-Verlag Wien 2013
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Table 1 Changes in ranking
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