COPD And Cognitive Impairment: The Role Of Hypoxemia And Oxygen Therapy

Thakur, Neeta; Blanc, Paul D.; Julián, Laura; Yelin, Edward H.; Katz, Patricia P.; Sidney, Stephen; Iribarren, Carlos; Eisner, Mark D.

doi:10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a4125

Cited by 97 publications

(165 citation statements)

References 23 publications

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“…There is however unanimity regarding their effect on the improvement of life expectancy or on variables such as the 6 minute walking test, red cell number or arterial lung pressures [8,9,10] . On the other hand, hypoxemic COPD seems to have a cognitive impairment profile different from that of normal and demented subjects, with verbal memory and praxic/executive function being the most affected, as shown by Antonelli et al [7,1]. The aim of this study was to propose a method that can be done in the patient's home, does not require specialized health technical support and reflects the fine motor brain control [11].…”

Section: Introductionmentioning

confidence: 94%

“…Chronic hypoxemia has deleterious effects in neuro-psychological and muscle function, with consequences in absent mindedness, perception, and realization of motor tasks [1].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies did not report any effects and others described positive ones [1,2,3,4,5,6]. Pretto et al showed that acute oxygen therapy did not improve cognitive and driving performance in chronic hypoxemic pulmonary obstructive disease patients (COPD) [6].…”

Section: Introductionmentioning

confidence: 99%

“…Pretto et al showed that acute oxygen therapy did not improve cognitive and driving performance in chronic hypoxemic pulmonary obstructive disease patients (COPD) [6]. Conversely, regular use of supplemental oxygen therapy decreased the risk for cognitive impairment in patients with COPD [1]. It is probable that the difference among these results is due to the fact that tests are not completely sensitive to O 2 changes, or are dependent on disease severity [7].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Short term oxygen therapy effects in hypoxemic patients measured by drawing analysis

Fiz¹,

Faundez-Zanuy

Monte³

et al. 2015

Computer Methods and Programs in Biomedicine

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show abstract

Section: Introductionmentioning

confidence: 94%

“…Chronic hypoxemia has deleterious effects in neuro-psychological and muscle function, with consequences in absent mindedness, perception, and realization of motor tasks [1].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Short term oxygen therapy effects in hypoxemic patients measured by drawing analysis

Fiz¹,

Faundez-Zanuy

Monte³

et al. 2015

Computer Methods and Programs in Biomedicine

View full text Add to dashboard Cite

show abstract

“…The choice of a particular molecule of ICS should be based on its pharmacodynamic and pharmacokinetic profiles, and should also take into consideration the liver function of the patient (because of the first pass metabolism of most ICSs), patient adherence to once daily (OD) or twice daily (BID) administration, local and systemic side effects that can be accepted and tolerated, and coadministered drugs that can modify hepatic metabolism of ICS. Similarly, the choice of the device should be based on the cognitive state, visual capacity, muscular or skeletal diseases that could impair coordination and handgrip, and lung functional impairment related to the effects of hypoxemia [67]. The reduced cognitive ability may obviously impact on the use of a device, which is a key factor for optimal control of chronic respiratory diseases.…”

Section: Practical Considerations For Elderly Patients On Long-term Dmentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

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Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

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Caring for the Older Person With Chronic Obstructive Pulmonary Disease

Fried¹,

Fragoso²,

Rabow³

2012

JAMA

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Chronic obstructive pulmonary disease (COPD) is a common disease in elderly patients. It is characterized by high symptom burden, healthcare utilization, mortality, and unmet needs of both patients and their caregivers. The treatment of the older patient with COPD is highly challenging. Although COPD is a major cause of respiratory failure and dyspnea in the elderly, multiple other disease entities, including heart failure, pulmonary embolism, and anxiety; medication effects; and other conditions, including deconditioning and malnutrition; may exacerbate COPD symptoms. Randomized controlled trials, which provide the strongest evidence for guideline recommendations, may underestimate the risk of adverse effects of interventions for older patients with COPD. The focus of guidelines on disease-modifying therapies may not address the full spectrum of both patient and caregiver needs engendered by the increasing burdens of advanced disease, particularly the high rates of bothersome symptoms, risk of functional and cognitive decline, and need for end-of-life care planning. Older patients tend to have a substantial disease burden coupled with functional and cognitive decline complicating the successful implementation of COPD treatments. Meeting the many needs of older COPD patients and their families requires that clinicians supplement guideline-recommended care with treatment decision making that takes into account older persons’ comorbid conditions, recognizes the trade-offs engendered by the increased risk of adverse events, focuses on symptom relief and function, and prepares patients and their loved ones for further declines in the patient’s health and their end-of-life care. A case of COPD in an 81 year old man hospitalized with severe dyspnea and respiratory failure is presented. This case highlights both the challenges in managing COPD in the elderly and the limitations in applying guidelines to geriatric patients.

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COPD And Cognitive Impairment: The Role Of Hypoxemia And Oxygen Therapy

Cited by 97 publications

References 23 publications

Short term oxygen therapy effects in hypoxemic patients measured by drawing analysis

Short term oxygen therapy effects in hypoxemic patients measured by drawing analysis

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

Caring for the Older Person With Chronic Obstructive Pulmonary Disease

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