The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has defined stage 1 chronic obstructive pulmonary disease (COPD) as forced expiratory volume in one second/forced vital capacity (FEV1/FVC)% <70% and a FEV1% predicted of >80%. Stage 2 has been defined as FEV1/FVC <70% and a FEV1% pred of <80%. The authors examined the extent of COPD misdiagnosis using this definition in healthy, never-smoker, asymptomatic adults aged >70 yrs in Bergen, Norway. A respiratory questionnaire was mailed to a random sample of 2,871 persons aged>70 yrs. In a random, well-defined subgroup of 208 never-smoker respondents with no current respiratory disease and significant dyspnoea or heart disease/hypertension complicated with dyspnoea, 71 were able to perform an acceptable spirometry. Approximately 35% of these healthy, elderly never-smokers had an FEV1/FVC% of <70% and would be classified as having at least a stage 1 COPD. This percentage increased with age and in those aged >80 yrs ∼50% would be classified as having COPD and approximately one-third would have an FEV1of <80% pred (stage 2 COPD). The estimated 5th percentile of FEV1was consistently <80% pred.The Global Initiative for Chronic Obstructive Lung Disease criteria will probably lead to a significant degree of over-diagnosis of chronic obstructive pulmonary disease in those aged >70 yrs. The criteria used to define the various stages of chronic obstructive pulmonary disease need to be age-specific.

Bone mineral density decreases with advancing chronic obstructive pulmonary disease (COPD) severity, but it is not known whether this is reflected in higher fracture rates. The present authors wanted to compare the prevalence of vertebral deformities in COPD patients with those in a population-based reference group to determine whether the number of deformities was related to the severity of COPD and how far the use of oral corticosteroids (OCS) influenced the prevalence of deformities.In the present cross-sectional study of 465 COPD patients and 462 controls, vertebral deformities were found in 31% of the COPD patients and 18% of the controls. In subjects who had never or sporadically used OCS, deformities were found in 29% of the COPD patients and 17% of the controls. In females, the average number of vertebral deformities was almost two-fold when COPD severity increased from Global Initiative of Chronic Obstructive Lung Disease stage II to III. In males, the use of OCS had a small but significant influence.Prevalence of vertebral deformities was significantly higher in chronic obstructive pulmonary disease patients than in the controls. In females, the average number of deformities was related to chronic obstructive pulmonary disease severity even after adjustment for other known risk factors. The difference between patients and controls remained significant even in those who never or sporadically used oral corticosteroids.

No abstract

Background: It is well known that body position can have an effect on gas exchange though the magnitude of this effect has not been studied thoroughly in the elderly. Objectives: This study analyzes the effect body position change has on arterial oxygen tension (PaO₂) and arterial carbon dioxide tension (PaCO₂) in healthy elderly. Methods: We tested 46 ‘lung-healthy’ elderly, including 30 women and 16 men, 67–88 years of age. Blood was drawn from the radial artery first in the sitting position and subsequently in the supine position. Spirometry was performed. Results: Mean (SD) sitting PaO₂ was 10.53 kPa (1.22), whereas mean supine PaO₂ was 9.85 kPa (1.33). The difference between sitting and supine PaO₂ was 0.68 kPa (0.86) and was statistically significant. Sitting PaCO₂ was 5.06 kPa (0.47) and supine PaCO₂ was 5.05 kPa (0.54). The difference between sitting and supine PaO₂ correlated positively with FEV₁/FVC %, negatively with the corresponding difference between sitting and supine PaCO₂,and negatively with BMI. Conclusions: We conclude that the significant difference in PaO₂ in sitting and supine positions clearly shows that the position needs to be considered both when attempting to establish reference values and when evaluating gas exchange in elderly persons. The positional changes in oxygenation are related to the corresponding change in PaCO₂, and to FEV₁/FVC % and BMI.

This study presents reference values for whole-breath and within-breath impedance parameters in asymptomatic elderly aged >70 years using the IOS method. We found higher resistance measurements than what is reported in previous studies and significantly larger frequency dependence.