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Essentials of Diagnosis

  • Symptoms: dyspnea, cough, sputum production, and wheeze.

  • Risk factors: tobacco smoke, air pollution.

  • Spirometry: airflow obstruction that is not fully reversible.

General Principles in Older Adults

Chronic obstructive pulmonary disease (COPD) is a common pulmonary condition characterized by persistent airflow obstruction that is not fully reversible with bronchodilators. COPD is a major cause of morbidity and mortality in the United States and worldwide. In the United States, COPD affects 5% to 20% of the adult population, depending on the population studied. COPD is of special concern to older adults, as its prevalence rises steeply with age, affecting up to 10% of the older adult population. Over the past 30 years, mortality from COPD has increased substantially in the United States, and the number of women dying from COPD has surpassed the number for men. COPD is now the third leading cause of death in the United States, accounting for more than 126,000 deaths in 2005, and it is the fourth leading cause of death worldwide.

COPD represents a major public health challenge, as it is largely preventable and treatable, and, yet, it is the only common chronic illness where morbidity and mortality continue to climb. It is a significant cause of hospitalization, particularly in the older population. Rates of hospitalization for COPD increased more than 30% between 1992 and 2006. In 2006, COPD accounted for approximately 672,000 hospital discharges in the United States. The hospitalization rate for those 65 years of age and older was 4 times higher than for those in the 45–64 years of age group. According to the National Heart, Lung, and Blood Institute, the national projected annual cost for COPD in 2010 was $49.9 billion. COPD is a more costly disease than asthma, and the majority of those costs are related to services associated with exacerbations. The burden of COPD is projected to increase in the coming decades as a result of continued exposure to COPD risk factors and the aging of the population.

COPD is defined as an inflammatory respiratory disease involving persistent airflow limitation that is incompletely reversible with bronchodilators. The airflow obstruction is usually progressive and associated with an abnormal chronic inflammatory response of the lungs to noxious particles or gases, primarily associated with cigarette smoking. Current definitions of COPD no longer include the terms “emphysema” and “chronic bronchitis,” although such terms are still used clinically. Emphysema is defined pathologically and refers to the destruction of the alveoli, the gas-exchanging surfaces of the lung, resulting in the enlargement of the airspaces distal to the terminal bronchioles. Chronic bronchitis is a clinical term that is used to describe the presence of cough and sputum production for at least 3 months during each of 2 consecutive years.

Pathogenesis

Estimates of the prevalence of COPD depend on the definition and criteria used, and vary widely, ranging ...

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