Chronic Obstructive Pulmonary Disease in the elderly

• COPD is highly prevalent, but it frequently remains unrecognized in the elderly.
• A relevant proportion of elderly people cannot perform a satisfactory spirometry.
• COPD dramatically impacts health status of elderly patients.
• Comorbidity has a major prognostic role but frequently remains unrecognized.
• Recommendations coming from clinical trials only partly apply to the elderly.
• The internists should aim at providing a truly comprehensive and effective treatment.

The prevalence of Chronic Obstructive Pulmonary Disease (COPD) dramatically increases with age, and COPD complicated by chronic respiratory failure may be considered a geriatric condition. Unfortunately, most cases remain undiagnosed because of atypical clinical presentation and difficulty with current respiratory function diagnostic standards. Accordingly, the disease is under-recognized and undertreated. This is expected to impact noticeably the health status of unrecognized COPD patients because a timely therapy could mitigate the distinctive and important effects of COPD on the health status. Comorbidity also plays a pivotal role in conditioning both the health status and the therapy of COPD besides having major prognostic implication.Several problems affect the overall quality of the therapy for the elderly with COPD, and current guidelines as well as results from pharmacological trials only to some extent apply to this patient. Finally, physicians of different specialties care for the elderly COPD patient: physician's specialty largely determines the kind of approach.In conclusion, COPD, in itself a complex disease, becomes difficult to identify and to manage in the elderly. Interdisciplinary efforts are desirable to provide the practicing physician with a multidisciplinary guide to the identification and treatment of COPD.