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.
Schlüsselwörter
Geriatrie - Atemwegserkrankungen - chronisch obstruktive Lungenerkrankung - Multimorbidität
- Luftnot
Keywords
geriatrics - respiratory diseases - chronic obstructive pulmonary disease - multimorbidity
- shortness of breath
