Considerations for managing chronic obstructive pulmonary disease in the elderly

Figures & data

Figure 1 Prevalence of COPD among adults in the US by age group and gender from 2007 to 2009.^1,2

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 1 Classification of severity of airflow limitation in COPD based on post-bronchodilator spirometry

GOLD category	FEV1
In patients with FEV1/FVC <0.70
1. Mild	FEV1 ≥80% predicted
2. Moderate	50% ≤FEV1 <80% predicted
3. Severe	30% ≤FEV1 <50% predicted
4. Very severe	FEV1 <30% predicted

Note: Reproduced with permission from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).³

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity.

Table 2 Initial pharmacologic management of COPD

Patient category	Characteristics	Risk assessment		Symptoms		Inhaled pharmacologic management of COPDa
		Spirometric classification	Exacerbations per year	mMRC score	CAT score
A	Low risk Fewer symptoms	GOLD 1–2	≤1	0–1	<10	Short-acting anticholinergic as needed or Short-acting beta2 agonist as needed
B	Low risk More symptoms	GOLD 1–2	≤1	≥2	≥10	Long-acting anticholinergic or long-acting beta2 agonist
C	High risk Fewer symptoms	GOLD 3–4	≥2	0–1	<10	Corticosteroid combined with long-acting anticholinergic or long-acting beta2 agonist
D	High risk More symptoms	GOLD 3–4	≥2	≥2	≥10	Corticosteroid combined with long-acting anticholinergic or long-acting beta2 agonist

Notes:

a Medications in each box are mentioned in alphabetical order. Reproduced with permission from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).³

Abbreviations: CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; mMRC score, modified Medical Research Council score.

Figure 2 Decrease in frequency of successful use of pressurized MDI with patient age based on data reported by Giraud and Roche.²⁶ Results are based on physicians’ observations of 3955 patients with asthma who were currently being treated with an inhaled corticosteroid for at least 3 months and an on-demand short-acting beta-agonist, both delivered by pressurized MDI. P-value for between-group comparison was calculated by Pearson’s Chi-squared test.

Abbreviation: MDI, metered dose inhaler.

Table 3 Available formulations of inhaled COPD medications

Drug	Pressurized MDI	DPI	Nebulizer
Beta2agonists
Short-acting
Fenoterol	•		•
Levalbuterol	•		•
Salbutamol (albuterol)	•	•	•
Terbutaline		•
Long-acting
Formoterol	•	•	•
Arformoterol			•
Indacaterol		•
Salmeterol	•	•
Anticholinergics
Short-acting
Ipratropium bromide	•		•
Oxitropium bromide	•		•
Long-acting
Tiotropium	•
Corticosteroids
Beclomethasone	•	•	•
Budesonide		•	•
Fluticasone	•	•
Combination products
Short-acting beta2 agonists plus short-acting anticholinergic
Fenoterol + ipratropium	•		•
Salbutamol + ipratropium	•		•
Long-acting beta2 agonists plus corticosteroids
Formoterol + budesonide	•	•
Salmeterol + fluticasone	•	•

Note: Reproduced with permission from the Global Initiative for Chronic Obstructive Lung Disease (GOLD).³

Abbreviations: COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; MDI, metered dose inhaler.

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