Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) in Aging Populations

Abstract

Current epidemiologic practice evaluates COPD based on self-reported symptoms of chronic bronchitis, self-reported physician-diagnosed COPD, spirometry confirmed airflow obstruction, or emphysema diagnosed by volumetric computed chest tomography (CT). Because the highest risk population for having COPD includes a predominance of middle-aged or older persons, aging related changes must also be considered, including: 1) increased multimorbidity, polypharmacy, and severe deconditioning, as these identify mechanisms that underlie respiratory symptoms and can impart a complex differential diagnosis; 2) increased airflow limitation, as this impacts the interpretation of spirometry confirmed airflow obstruction; and 3) “senile” emphysema, as this impacts the specificity of CT-diagnosed emphysema. Accordingly, in an era of rapidly aging populations worldwide, the use of epidemiologic criteria that do not rigorously consider aging related changes will result in increased misidentification of COPD and may, in turn, misinform public health policy and patient care.

Keywords:

• aging
• COPD
• epidemiology
• GOLD
• spirometry

Acknowledgments

Special thanks to the Yale Program on Aging and the Veterans Affairs Clinical Epidemiology Research ­Center, including Drs. Gail McAvay, Peter H Van Ness, John Concato, H. Klar Yaggi, and Thomas M. Gill. The current work is inspired by the many research contributions of Drs. Philip Quanjer and Paul Enright.

Funding

The author is a recipient of a Merit Award from the United States Department of Veterans Affairs.

Declaration of Interest Statement

Dr. Vaz Fragoso takes full responsibility for the content of this work. The author reports no conflicts of interest, including no commercial support.