Chronic obstructive pulmonary disease (COPD) is a common problem in the elderly, characterized by obstruction of airflow that cannot be fully reversed with inhaler medications, called bronchodilators. It is characterized by intermittent worsening of symptoms and these episodes are called acute exacerbations, in which approximately half are caused by bacteria including Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Chlamydia pneumoniae.
It is a fourth leading cause of death and disability in the United States and is projected to rank fifth in 2020 as a worldwide burden of disease. According to the latest World Health Organization (WHO) statistics (2005), approximately 210 million people suffer from COPD worldwide, and 5% of all deaths globally are estimated to be due to this disease. This corresponds to more than 3 million deaths annually, of which 90% are thought to occur in low and middle-income countries. A recent projection published by the WHO Global Burden of Disease Project indicates that COPD will be the 3rd leading cause of death globally by the year 2030.
The most common symptoms of COPD are breathlessness and persistent cough with sputum production. As the condition worsens, even daily activities such as walking up a short flight of stairs or the exertion of washing or dressing become difficult. Despite being a treatable and preventable disease, the prevalence continues to rise because of the worldwide epidemic of smoking. Other risk factors may include air pollution, childhood infections, heredity, advanced age, airway hyper responsiveness, occupational exposures, male sex and socioeconomic status.
It has systemic effects, and common co-morbid conditions such as cardiovascular disease, muscle wasting and osteoporosis may all be linked through a common systemic inflammatory cascade. Depression, anxiety and malnutrition are also common in elderly COPD patients. These factors not only affect quality of life (QOL) but also compliance with therapy.
Chronic bronchitis occurs when the inflammatory process affects mainly the large airway walls, leading to mucus over-production and inflammatory swelling of the inner layers of the airways, with subsequent obstruction to airflow. Emphysema, on the other hand, is when the damage involves the delicate gas exchange part of the lungs, the tiny...