title: The pharmacological approach to the elderly COPD patient.
abstract: The elderly patient (65 years and older) with chronic obstructive pulmonary disease (COPD) can be a challenge to the clinician. This begins with the correct and early diagnosis, the assessment of disease severity, recognizing complicating comorbidities, determining the burden of symptoms, and monitoring the frequency of acute exacerbations. Comprehensive management of COPD in the elderly patient should improve health-related quality of life, lung function, reduce exacerbations, and promote patient compliance with treatment plans. Only smoking cessation and oxygen therapy in COPD patients with hypoxemia reduce mortality. Bronchodilators, corticosteroids, methylxanthines, phosphodiesterase-4 inhibitors, macrolide antibiotics, mucolytics, and pulmonary rehabilitation improve some outcome measures such as spirometry measures and the frequency of COPD exacerbations without improving mortality. International treatment guidelines to reduce symptoms and reduce the risk of acute exacerbations exist. Relief of dyspnea and control of anxiety are important. The approach to each patient is best individualized. Earlier use of palliative care should be considered when traditional pharmacotherapy fails to achieve outcome measures and before consideration of end-of-life issues.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, 4150 V Street, Suite 3400, Davis, CA, USA. tealbertson@ucdavis.edu
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Albertson
authors.forename: Michael
authors.initials: M
authors.lastname: Schivo
authors.forename: Amir A
authors.initials: AA
authors.lastname: Zeki
authors.forename: Samuel
authors.initials: S
authors.lastname: Louie
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sutter
authors.forename: Mark
authors.initials: M
authors.lastname: Avdalovic
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Chan
mesh_terms: D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000534:rehabilitation / Q000628:therapy; D016540:Smoking Cessation; D014611:Vaccination
chemical_list: D001993:Bronchodilator Agents