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.