Top

Drugs & Aging

Published in:

01-06-2009 | Review Article

Chronic Obstructive Pulmonary Disease in the Elderly

An Update on Pharmacological Management

Authors: Amy L. Dzierba, Dr Sanja Jelic

Published in: Drugs & Aging | Issue 6/2009

Abstract

The prevalence of chronic obstructive pulmonary disease (COPD) continues to rise in association with an aging Western society. While barriers to receiving optimal healthcare exist for aging patients, pharmacotherapy of COPD in the elderly is important because the treatment benefits in this group are comparable to those seen in the younger COPD population. The frequent presence of co-morbidities and reduced clearance capacity make selection of pharmacotherapy in elderly patients with stable COPD challenging. The adverse effects of standard therapy for COPD may also be more pronounced in elderly patients. A careful risk-versus-benefit assessment should always be carried out when prescribing long-term inhaled bronchodilator and corticosteroid therapy to an elderly COPD patient, and when prescribing β₂-adrenoceptor agonists and methylxanthines, in particular, to those with cardiovascular co-morbidities. The present review focuses on the special considerations regarding initiation and maintenance of pharmacotherapy in elderly patients with stable COPD.

National Center for Health Statistics. Report of final mortality statistics, 2005 [online]. Available from URL: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf [Accessed 2008 Apr 20]

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, 2007 [online]. Available from URL: http://www.goldcopd.org [Accessed 2008 Apr 20]

National Center for Health Statistics. Report of final mortality statistics, 2005 [online]. Available from URL http://www.cdc.gov/nchs/data/series/sr_10/sr10_235.pdf [Accessed 2008 Apr 20]

Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 2152–58PubMed

Wise RA. Changing smoking patterns and mortality from chronic obstructive pulmonary disease. Prev Med 1997; 26: 418–21PubMedCrossRef

Mapel DW, Hurley JS, Frost FJ, et al. Health care utilization in chronic obstructive pulmonary disease. Arch Intern Med 2000; 160: 2653–8PubMedCrossRef

Fuat A, Hungin AP, Murphy JJ. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ 2003; 326: 196PubMedCrossRef

Maciejewski ML, Perkins M, Li YF, et al. Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Serv Res 2007; 7: 56PubMedCrossRef

Michalsen A, Konig G, Thimme W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 1998; 80: 437–41PubMed

10.

Akazawa M, Stearns SC, Biddle AK. Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims. Health Serv Res 2008; 29: 1–19

11.

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: American Thoracic Society. Am J Respir Crit Care Med 1995; 152: S77–121

12.

O’Donnell DE, Aaron S, Bourbeau J, et al. Thoracic Society recommendation for management of chronic obstructive pulmonary disease — 2007 update. Can Respir J 2007; 14: S5B–32B

13.

World Health Organization. Definition of an older or elderly person [online]. Available from URL: http://www.who.int/healthinfo/survey/ageingdefnolder/en/ [Accessed 2008 Oct 18]

14.

Anthonisen NR, Connett JE, Enright PL, et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9PubMedCrossRef

15.

Guyatt GH, Townsend M, Pugsley SO, et al. Bronchodilators in acute airflow limitation: effects on airway function, exercise capacity, and quality of life. Am Rev Respir Dis 1987; 135: 1069–74PubMed

16.

Hanania NA, Donohue JF. Pharmacologic interventions in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007; 4: 526–34PubMedCrossRef

17.

Holt TB. Inhaled beta agonists. Respir Care 2007; 52: 820–32

18.

Bristow MR. Beta-adrenergic receptor blockade in chronic heart failure. Circulation 2000; 101: 558–69PubMedCrossRef

19.

Hanania NA, Sharafkhaneh A, Barber R, et al. β-Agonist intrinsic efficacy. Am J Respir Crit Care Med 2002; 165: 1353–8PubMedCrossRef

20.

Johnson M. The β-adrenoceptor. Am J Respir Crit Care Med 1998; 158: S146–53PubMed

21.

Boyd G, Morice AH, Pounsford JC, et al. An evaluation of salmeterol in the assessment of chronic obstructive pulmonary disease (COPD). Eur Respir J 1997; 10: 815–21PubMed

22.

Aalbers R, Ayres J, Backer V, et al. Formoterol in patients with chronic obstructive pulmonary disease: a randomized, controlled, 3 month trial. Eur Respir J 2002; 19: 936–43PubMedCrossRef

23.

Rennard SI, Anderson W, ZuWallack R, et al. Use of a long-acting inhaled β2-adrenergic agonist, salmeterol xinafoate, in patients with chronic obstructive disease. Am J Respir Crit Care Med 2001; 163: 1087–92PubMed

24.

Mahler DA, Donuhue JF, Barbee RA, et al. Efficacy of salmeterol xinafoate in the treatment of COPD. Chest 1999; 115:956–65CrossRef

25.

Stockley RA, Whitehead PJ, Williams MK. Improved outcomes in patients with chronic obstructive pulmonary disease treated with salmeterol compared with placebo/usual therapy: results of a meta-analysis. Respir Res 2006; 7: 147PubMedCrossRef

26.

Rodrigo GJ, Nannini LJ, Rodriguez-Roisin R. Safety of long-acting β-agonists in stable COPD. Chest 2008; 133: 1079–87PubMedCrossRef

27.

United States Food and Drug Administration. FDA Public Health Advisory: Serevent Diskus, Advir Diskus and Foradil [online]. Available from URL: http://www.fda.gov/CDER/Drug/advisory/LABA.htm [Accessed 2008 Apr 20]

28.

Nelson HS, Weiss ST, Bleecker ER, et al. on behalf of the SMART study group. The Salmeterol Multicenter Asthma Research Trial. Chest 2006; 129: 15–26

29.

Thomson NC, Chaudhuri R, Livingston E. Asthma and cigarette smoking. Eur Respir J 2004; 24: 822–33PubMedCrossRef

30.

Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339: 1194–200PubMedCrossRef

31.

Padeletti M, Jelic S, LeJemtel TH. Coexistent chronic obstructive pulmonary disease and heart failure in the elderly. Int J Cardiol 2008; 125: 209–15PubMedCrossRef

32.

Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of β-agonists in patients with asthma and COPD. Chest 2004; 125: 2309–21PubMedCrossRef

33.

Au DH, Lamaitre RN, Curtis JR, et al. The risk of myocardial infarction associated with inhaled β-adrenoreceptor agonists. Am J Respir Crit Care Med 2000; 161: 827–30PubMed

34.

Au DH, Curtis JR, Every NR, et al. Association between inhaled β-agonists and the risk of unstable angina and myocardial infarction. Chest 2002; 121: 846–51PubMedCrossRef

35.

GlaxoSmithKline. Ventolin [package insert]. Research Triangle Park (NC): GlaxoSmithKline, 2001

36.

Ferguson GT, Funck-Brentano C, Fischer T, et al. Cardiovascular safety of salmeterol in COPD. Chest 2003; 123: 1817–24PubMedCrossRef

37.

Tamaoki J, Chiyotani A, Tagaya E, et al. Effect of long term treatment with oxitropium bromide on airway secretion in chronic bronchitis and diffuse panbronchiolitis. Thorax 1994; 49: 545–8PubMedCrossRef

38.

Wise RA, Tashkin DP. Optimizing treatment of chronic obstructive pulmonary disease: an assessment of current therapies. Am J Med 2007; 120: S4–13PubMedCrossRef

39.

van Noord JA, Bantje ThA, Eland ME, et al. A randomized controlled comparison of tiotropium and ipratropium in the treatment of chronic obstructive pulmonary disease. Thorax 2000; 55: 289–94PubMedCrossRef

40.

Boehringer Ingelheim Pharmaceuticals. Tiotropium [package insert]. Ridgefield (CT): Boehringer Ingelheim Pharmaceuticals Inc., 2007

41.

Briggs DD, Covelli H, Lapidus R, et al. Improved daytime spirometric efficacy of tiotropium compared with salmeterol in patients with COPD. Pulm Pharmacol Ther 2005; 18: 397–404PubMedCrossRef

42.

Donohue JF, van Noord JA, Bateman ED, et al. A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest 2002; 122: 47–55PubMedCrossRef

43.

Brusasco V, Hodder R, Miravitlles M, et al. Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD. Thorax 2003; 58: 399–404PubMedCrossRef

44.

O’Donnell DE, Fluge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004; 23: 832–40PubMedCrossRef

45.

Rodrigo GJ, Nannini LJ. Tiotropium for the treatment of stable chronic obstructive pulmonary disease: a systematic review with meta-analysis. Pulm Pharmacol Ther 2007; 20: 495–502PubMedCrossRef

46.

Boehringer Ingelheim Pharmaceuticals. Atrovent [package insert]. Ridgefield (CT): Boehringer Ingelheim Pharmaceuticals Inc., 2007

47.

Pras E, Stienlauf S, Pinkhas J, et al. Urinary retention associated with ipratropium bromide. DICP 1991; 25: 939–40PubMed

48.

United States Food and Drug Administration. Early communication about ongoing safety review of tiotropium [online]. Available from URL: http://www.fda.gov/CDER/Drug/early_comm/tiotropium.htm [Accessed 2008 Apr 20]

49.

DeLuise C, Lanes SF, Jacobsen J, et al. Cardiovascular and respiratory hospitalizations and mortality among users of tiotropium in Denmark. Eur J Epidemiol 2007; 22: 267–72CrossRef

50.

Curkendall SM, DeLuise C, Jones JK, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 2006; 16: 63–70PubMedCrossRef

51.

Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease. JAMA 2008; 300: 1439–50PubMedCrossRef

52.

Viires N, Aubier M, Murciano D, et al. Effects of theophylline on isolated diaphragmatic fibers: a model for pharmacologic studies on diaphragmatic contractility. Am Rev Respir Dis 1986; 133: 1060–4PubMed

53.

Murciano D, Auclair MH, Pariente R, et al. A randomized, controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease. N Engl J Med 1989; 320: 1521–5PubMedCrossRef

54.

McKay SE, Howie CA, Thomson AH, et al. Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. Thorax 1993; 48(3): 227–32PubMedCrossRef

55.

Moxham J. Aminophylline and the respiratory muscles: an alternative view. Clin Chest Med 1988; 9: 325–36PubMed

56.

ZuWallack R, Mahler DA, Reilly D, et al. Salmeterol plus theophylline combination therapy in the treatment of COPD. Chest 2001; 119: 1661–70PubMedCrossRef

57.

Barr RG, Rowe BH, Camargo CA. Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomized trials. BMJ 2003; 327: 6CrossRef

58.

O’Mahony MS, Woodhouse KW. Age environmental and drug metabolism. Pharmacol Ther 1994; 61: 279–87PubMedCrossRef

59.

Le Couteur DG, McLean AJ. The aging liver: drug clearance and oxygen diffusion barrier hypothesis. Clin Pharmacokinet 1998; 34: 359–73PubMedCrossRef

60.

Tanaka E. In vitro age-related changes in hepatic drug-oxidizing capacity in humans. J Clin Pharm Ther 1998; 23: 247–55PubMedCrossRef

61.

Jackson SH, Johnston A, Woolard R, et al. The relationship between theophylline clearance and age in adult life. Eur J Clin Pharmacol 1989; 36: 29–34PubMedCrossRef

62.

COMBIVENT Inhalation Aerosol Study Group. In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: an 85-day multicenter trial. Chest 1994; 105: 1411–19CrossRef

63.

Campbell S. For COPD a combination of ipratropium bromide and albuterol sulfate is more effective than albuterol base. Arch Intern Med 1999; 159: 156–60PubMedCrossRef

64.

van Noord JA, Aumann JL, Janssens E, et al. Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD. Eur Respir J 2005; 26: 214–22PubMedCrossRef

65.

van Noord JA, Aumann JL, Janssens E, et al. Effects of tiotropium with and without formoterol on airflow obstruction and resting hyperinflation in patients with COPD. Chest 2006; 129: 509–17PubMedCrossRef

66.

Aaron SD, Vandermheen KL, Fergusson D, et al. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for the treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2007; 146: 545–55PubMed

67.

Tashkin DP, Celli B, Senn S, et al. A 4-year trial to tiotropium in chronic obstructive pulmonary disease. N Engl J Med 2008; 359: 1543–54PubMedCrossRef

68.

O’Donnell DE, Voduc N, Fitzpatrick M, et al. Effect of salmeterol on the ventilatory response to exercise in COPD. Eur Respir J 2004; 24: 86–94PubMedCrossRef

69.

Casaburi R, Kukafka D, Cooper CB, et al. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest 1995; 127: 809–17CrossRef

70.

ZuWallack RL. The roles of bronchodilators, supplemental oxygen, and ventilatory assistance in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease. Respir Care 2008; 53: 1190–95PubMed

71.

Calverely PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive disease. N Engl J Med 2007; 356: 775–89CrossRef

72.

Pauwels RA, Lofdahl CG, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med 1999; 340: 1948–53

73.

Vestbo J, Sorensen T, Lange P, et al. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomized controlled trial. Lancet 1999; 353: 1819–23PubMedCrossRef

74.

Burge PS, Calverley PM, Jones PW, et al. Randomized, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320: 1297–303PubMedCrossRef

75.

The Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease: Lung Health Study II. N Engl J Med 2000; 343: 1902–9CrossRef

76.

Soriano JB, Sin DD, Zhang X, et al. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo. Chest 2007; 131: 682–9PubMedCrossRef

77.

Donaldson GC, Seemungal TA, Patel IS, et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 2005; 128: 1995–2004PubMedCrossRef

78.

Spencer S, Calverley PM, Burge PS, et al. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J 2004; 23(5): 698–702PubMedCrossRef

79.

Alsaeedi A, Sin DD, McAlister FA. The effects of inhaled corticosteroids in chronic pulmonary obstructive disease: a systematic review of randomized placebo-controlled trials. Am J Med 2002; 113: 59–65PubMedCrossRef

80.

Gartlehner G, Hanson RA, Carson SS, et al. Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Ann Fam Med 2006; 4: 253–62PubMedCrossRef

81.

van der Valk P, Monninkhof E, van der Palen J, et al. Effect of discontinuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: the COPE study. Am J Respir Crit Care Med 2002; 166(10): 1358–63PubMedCrossRef

82.

Calverley PM, Pauwels R, Vestbo J, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: randomized controlled trial. Lancet 2003; 361: 449–56PubMedCrossRef

83.

Szafranski W, Cukier A, Ramirez A, et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 2003; 21: 74–81PubMedCrossRef

84.

Calverley PM, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003; 22: 912–8PubMedCrossRef

85.

Sin DD, Wu L, Anderson JA, et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax 2005; 60: 992–7PubMedCrossRef

86.

Kardos P, Wencker M, Glaab T, et al. Impact of salmeterol/fluticasone propionate versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 175: 144–9PubMedCrossRef

87.

Huiart L, Ernst P, Ranouil X, et al. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634–9PubMedCrossRef

88.

Varas-Lorenzo C, Rodriguez LA, Maguire A, et al. Use of oral corticosteroids and the risk of acute myocardial infarction. Atherosclerosis 2007; 192: 376–83PubMedCrossRef

89.

Ernst P, Gonzalez AV, Brassard P, et al. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 2007; 176: 162–6PubMedCrossRef

90.

Nazir SA, Al-Hamed MM, Erbland ML. Chronic obstructive pulmonary disease in the older patient. Clin Chest Med 2007; 28: 703–15PubMedCrossRef

91.

Chapman KR, Love L, Brubaker H. A comparison of breath-actuated and conventional meter-dose inhaler inhalation techniques in elderly subjects. Chest 1993; 104: 1332–7PubMedCrossRef

92.

Ho SF, O’Mahoney MS, Steward JA, et al. Inhaler technique in older people in the community. Age Ageing 2004; 33: 185–8PubMedCrossRef

93.

Jarvis S, Ind PW, Shiner RJ. Inhaled therapy in elderly COPD patients: time for re-evaluation? Age Ageing 2007; 36: 213–8PubMedCrossRef

94.

Teale C, Jones A, Patterson CT, et al. Community survey of home nebulized technique by elderly people. Age Ageing 1995; 24: 276–7PubMedCrossRef

95.

Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines. Chest 2005; 127: 335–71PubMedCrossRef

Title: Chronic Obstructive Pulmonary Disease in the Elderly
An Update on Pharmacological Management
Authors: Amy L. Dzierba
Dr Sanja Jelic
Publication date: 01-06-2009
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 6/2009
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200926060-00001

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2009

Medication Problems in Older, Newly Diagnosed Cancer Patients in Canada: How Common are They?

Patterns of Drug Use and Factors Associated with Polypharmacy and Excessive Polypharmacy in Elderly Persons

Hospitalizations because of Adverse Drug Reactions in Elderly Patients Admitted through the Emergency Department

“I Just Take What I Am Given”

Constipation in the Elderly

Management of Secondary Hyperparathyroidism in the Elderly Patient with Chronic Kidney Disease

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials