COPD beim älteren Menschen

Das Risiko, an einer chronisch-obstruktiven Lungenerkrankung (COPD) zu erkranken, steigt mit der Lebenserwartung und beträgt fast 30% [1]. Neben den bekannten Risikofaktoren für die COPD, in Westeuropa v.a. das Zigarettenrauchen, stellt auch die Zellalterung einen Risikofaktor für die COPD dar. In wenigen Jahren wird ein Viertel der Bundesbürger älter als 65 Jahre sein. Dieser Beitrag vermittelt die Besonderheit geriatrischer Aspekte alter Patienten mit COPD, um als Pneumologe auch diese herausfordernde Patientengruppe erfolgreich behandeln zu können.

Abstract

The lifetime risk of developing COPD is estimated to be between 25 and 30% (10% risk for COPD stage II or worse). It is projected that COPD will become the third leading cause of death within the next decade. COPD may be understood as a disease of accelerated lung ageing: The accumulation of senescent cells in the lungs results in the loss of repair ability and the release of inflammatory mediators. Geriatric patients typically present with multimorbidity, polypharmacy, restrictions in daily life, frailty and sarcopenia. Up to two-thirds of elderly patients with COPD have dysphagia, which leads to aspiration in 40% of cases and is prognostically unfavourable. Older patients with COPD are less likely to experience breathlessness than younger patients. In old patients with COPD, spirometry is the most important lung function test. FEV₆ instead of the FVC may be used. The clock test, mini-cog and the ability to draw two pentagons on top of each other are the best ways to screen patients with dementia to determine whether spirometry is feasible. Impulse oscillometry is a well investigated lung function test for elderly patients with COPD with the advantage not to require special cooperation. The 1-minute walking test or the 1-minute sit-to-stand test are good geriatric alternatives for the 6-minute walking test. The treatment is based on the current COPD guidelines. Substances with a long duration of action, such as fluticasone furoate, vilanterol and umeclidinium, are the best option. The capillary PO₂ is 6 mmHg higher than the arterial PO₂. The difference is even greater in heart failure. The ventilation-perfusion distribution disorder also increases with age, particularly when lying down. This is due to the increase in occlusion capacity, which causes the small airways to collapse earlier. It is essential to consider comorbidities and body position during blood gas sampling to avoid an oversupply of home oxygen therapy in old age.

Kernaussagen

• Charakteristische Einschränkungen im Alter werden mit den Begriffen Sarkopenie, Frailty, Multimorbidität und Polypharmazie umschrieben, die zu einer Einschränkung von Alltagsaktivitäten führen.

• Die Gruppe der älteren Menschen ist heterogen. Das geriatrische Assessment ermöglicht eine Differenzierung, die praktische Relevanz für die weitere Versorgung hat.

• Das Abzeichnen zweier sich überlappenden Fünfecke im Rahmen des MMSE ist prädiktiv dafür, ob bei alten Patienten die Durchführung einer Lungenfunktionsprüfung möglich ist.

• Die Durchführung einer Spirometrie ist für ältere Menschen leichter durchzuführen als eine Bodyplethysmografie.

• Der PO₂ ist bei alten Personen im Liegen besonders niedrig, was bei immobilen Patienten nicht zu einer Überversorgung in der Verordnung einer häuslichen Sauerstofftherapie führen darf.

• Liegt eine Herzinsuffizienz vor, vergrößert sich durch die Zunahme der peripheren Sauerstoffextraktion der Unterschied zwischen kapillären und arteriellem PO₂ noch weiter (normal 6 mmHg).

• Auch alte Patienten sollen klinisch von der Einleitung einer häuslichen Sauerstofftherapie profitieren. Wenn sie nicht in der Lage sind, dies in Worten auszudrücken (Demenz, Schlaganfall), steht die Krankenbeobachtung im Vordergrund (Normalisierung einer Tachypnoe, Besserung von Unruhe).

Schlüsselwörter

Geriatrie - Atemwegserkrankungen - chronisch obstruktive Lungenerkrankung - Multimorbidität - Luftnot

Keywords

geriatrics - respiratory diseases - chronic obstructive pulmonary disease - multimorbidity - shortness of breath

Publication History

Article published online:
12 May 2025

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