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Chronic Obstructive Pulmonary Disease

An Update on Diagnosis and Management Issues in Older Adults

Abstract

Chronic obstructive pulmonary disease (COPD) is a debilitating disease of the elderly that causes significant morbidity and mortality. Despite being a treatable and preventable disease, the prevalence continues to rise because of the worldwide epidemic of smoking. COPD is associated with enormous healthcare costs. It has systemic effects, and common co-morbid conditions such as cardiovascular disease, muscle wasting and osteoporosis may all be linked through a common systemic inflammatory cascade. Depression, anxiety and malnutrition are also common in elderly COPD patients. These factors not only affect quality of life (QOL) but also compliance with therapy. Malnutrition is an independent predictor of mortality and poor outcome. Spirometry is essential for the diagnosis of COPD, but the criteria defining airflow limitation are not clear cut for elderly patients and could result in over-diagnosis. However, older patients perceive their symptoms differently, and COPD could also be under-diagnosed in this population. Acute exacerbations result in worsening symptoms that necessitate additional treatment, and may cause a more rapid decline in lung function and QOL. The management of elderly patients with COPD should encompass a multidisciplinary approach. An evaluation of patients’ nutritional status and mental health should be undertaken, in addition to assessing their lung function and functional impairment. Significant underlying co-morbidities should be evaluated and treated to derive the maximal benefit of therapy. Specific therapy for COPD should start with cessation of exposure to the most important risk factor, tobacco smoke. Smoking cessation rates in the elderly have not declined, and this may reflect an underlying reluctance by physicians to counsel and offer smoking cessation therapies to the elderly. Unlike oxygen therapy in hypoxaemic patients, bronchodilators and corticosteroids do not decrease mortality in COPD patients and they are primarily directed towards symptom relief. However, they do have a positive effect on QOL and exacerbation rates. The choice of delivery devices for inhaled medications is important in the elderly, and patients’ inhaler technique and manual dexterity should be frequently assessed. Pulmonary rehabilitation and nutritional supplementation are other important components of care. End-of-life issues should be adequately addressed in the elderly with COPD, and an approach integrating curative and palliative interventions is recommended.

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References

  1. 1.

    Agusti A. Systemic effects of chronic obstructive pulmonary disease: what we know and what we don’t know (but should). Proc Am Thorac Soc 2007 Oct 1; 4(7): 522–5

  2. 2.

    Sin DD, Anthonisen NR, Soriano JB, et al. Mortality in COPD: role of comorbidities. Eur Respir J 2006 Dec; 28(6): 1245–57

  3. 3.

    Hurd SS. International efforts directed at attacking the problem of COPD. Chest 2000 May; 117 (5 Suppl. 2): 336S–8S

  4. 4.

    Jemal A, Ward E, Hao Y, et al. Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005 Sep 14; 294(10): 1255–9

  5. 5.

    CDC. Deaths from chronic obstructive pulmonary disease: United States, 2000–2005. MMWR Morb Mortal Wkly Rep 2008 Nov 14; 57(45): 1229–32

  6. 6.

    Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006 Feb; 27(2): 397–412

  7. 7.

    Garrett N, Martini EM. The boomers are coming: a total cost of care model of the impact of population aging on the cost of chronic conditions in the United States. Dis Manag 2007 Apr; 10(2): 51–60

  8. 8.

    Mannino DM. COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity. Chest 2002 May; 121(5 Suppl.): 121S–6S

  9. 9.

    Miller JD, Foster T, Boulanger L, et al. Direct costs of COPD in the US: an analysis of Medical Expenditure Panel Survey (MEPS) data. COPD 2005 Sep; 2(3): 311–8

  10. 10.

    Miravitlles M, Murio C, Guerrero T, et al. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002 May; 121(5): 1449–55

  11. 11.

    Menzin J, Boulanger L, Marton J, et al. The economic burden of chronic obstructive pulmonary disease (COPD) in a US Medicare population. Respir Med 2008 Sep; 102(9): 1248–56

  12. 12.

    Mannino DM, Watt G, Hole D, et al. The natural history of chronic obstructive pulmonary disease. Eur Respir J 2006 Mar; 27(3): 627–43

  13. 13.

    Rutgers SR, ten Hacken NH, Koeter GH, et al. Borg scores before and after challenge with adenosine 5′-monophosphate and methacholine in subjects with COPD and asthma. Eur Respir J 2000 Sep; 16(3): 486–90

  14. 14.

    Ottanelli R, Rosi E, Ronchi MC, et al. Perception of bronchoconstriction in smokers with airflow limitation. Clin Sci (Lond) 2001 Nov; 101(5): 515–22

  15. 15.

    Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007 Sep 15; 176(6): 532–55

  16. 16.

    Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005 Nov; 26(5): 948–68

  17. 17.

    Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 1999 Jan; 159(1): 179–87

  18. 18.

    Hansen JE, Sun XG, Wasserman K. Spirometric criteria for airway obstruction: use percentage of FEV1/FVC ratio below the fifth percentile, not <70%. Chest 2007 Feb; 131(2): 349–55

  19. 19.

    Gelb AF, Zamel N. Effect of aging on lung mechanics in healthy nonsmokers. Chest 1975 Oct; 68(4): 538–41

  20. 20.

    Burrows B, Lebowitz MD, Camilli AE, et al. Longitudinal changes in forced expiratory volume in one second in adults: methodologic considerations and findings in healthy nonsmokers. Am Rev Respir Dis 1986 Jun; 133(6): 974–80

  21. 21.

    Medbo A, Melbye H. Lung function testing in the elderly: can we still use FEV1/FVC <70% as a criterion of COPD? Respir Med 2007 Jun; 101(6): 1097–105

  22. 22.

    Celli BR, Halbert RJ, Isonaka S, et al. Population impact of different definitions of airway obstruction. Eur Respir J 2003 Aug; 22(2): 268–73

  23. 23.

    Hardie JA, Buist AS, Vollmer WM, et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur Respir J 2002 Nov; 20(5): 1117–22

  24. 24.

    Mannino DM, Buist AS, Vollmer WM. Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function? Thorax 2007 Mar; 62(3): 237–41

  25. 25.

    Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001 Apr; 163(5): 1256–76

  26. 26.

    Burrows B, Knudson RJ, Cline MG, et al. Quantitative relationships between cigarette smoking and ventilatory function. Am Rev Respir Dis 1977 Feb; 115(2): 195–205

  27. 27.

    Orozco-Levi M, Garcia-Aymerich J, Villar J, et al. Wood smoke exposure and risk of chronic obstructive pulmonary disease. Eur Respir J 2006 Mar; 27(3): 542–6

  28. 28.

    Perez-Padilla R, Regalado J, Vedal S, et al. Exposure to biomass smoke and chronic airway disease in Mexican women: a case-control study. Am J Respir Crit Care Med 1996 Sep; 154 (3 Pt 1): 701–6

  29. 29.

    Halonen JI, Lanki T, Yli-Tuomi T, et al. Urban air pollution, and asthma and COPD hospital emergency room visits. Thorax 2008 Jul; 63(7): 635–41

  30. 30.

    Celli BR, Halbert RJ, Nordyke RJ, et al. Airway obstruction in never smokers: results from the Third National Health and Nutrition Examination Survey. Am J Med 2005 Dec; 118(12): 1364–72

  31. 31.

    Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2002 Oct 15; 156(8): 738–46

  32. 32.

    Zeskind JE, Lenburg ME, Spira A. Translating the COPD transcriptome: insights into pathogenesis and tools for clinical management. Proc Am Thorac Soc 2008 Dec; 5(8): 834–41

  33. 33.

    Tobin MJ, Cook PJ, Hutchison DC. Alpha 1 antitrypsin deficiency: the clinical and physiological features of pulmonary emphysema in subjects homozygous for Pi type Z: a survey by the British Thoracic Association. Br J Dis Chest 1983 Jan; 77(1): 14–27

  34. 34.

    Smith CA, Harrison DJ. Association between polymorphism in gene for microsomal epoxide hydrolase and susceptibility to emphysema. Lancet 1997 Aug 30; 350(9078): 630–3

  35. 35.

    Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000 Dec; 162(6): 2152–8

  36. 36.

    Chen Y, Horne SL, Dosman JA. Increased susceptibility to lung dysfunction in female smokers. Am Rev Respir Dis 1991 Jun; 143(6): 1224–30

  37. 37.

    Prescott E, Bjerg AM, Andersen PK, et al. Gender difference in smoking effects on lung function and risk of hospitalization for COPD: results from a Danish longitudinal population study. Eur Respir J 1997 Apr; 10(4): 822–7

  38. 38.

    Prescott E, Lange P, Vestbo J. Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study. Eur Respir J 1999 May; 13(5): 1109–14

  39. 39.

    Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008 Nov 27; 359(22): 2355–65

  40. 40.

    Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet 2007 Sep 1; 370(9589): 741–50

  41. 41.

    Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med 2004 Jun 24; 350(26): 2645–53

  42. 42.

    Vernooy JH, Kucukaycan M, Jacobs JA, et al. Local and systemic inflammation in patients with chronic obstructive pulmonary disease: soluble tumor necrosis factor receptors are increased in sputum. Am J Respir Crit Care Med 2002 Nov 1; 166(9): 1218–24

  43. 43.

    Hurst JR, Perera WR, Wilkinson TM, et al. Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006 Jan 1; 173(1): 71–8

  44. 44.

    Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet 2007 Sep 1; 370(9589): 797–9

  45. 45.

    Gan WQ, Man SF, Senthilselvan A, et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis. Thorax 2004 Jul; 59(7): 574–80

  46. 46.

    Gerhardsson de Verdier M. The big three concept: a way to tackle the health care crisis? Proc Am Thorac Soc 2008 Dec; 5(8): 800–5

  47. 47.

    Agusti A, Morla M, Sauleda J, et al. NF-kappaB activation and iNOS upregulation in skeletal muscle of patients with COPD and low body weight. Thorax 2004 Jun; 59(6): 483–7

  48. 48.

    Agusti AG, Sauleda J, Miralles C, et al. Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002 Aug 15; 166(4): 485–9

  49. 49.

    Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003 Mar 25; 107(11): 1514–9

  50. 50.

    McEvoy CE, Ensrud KE, Bender E, et al. Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998 Mar; 157 (3 Pt 1): 704–9

  51. 51.

    Marquis K, Maltais F, Duguay V, et al. The metabolic syndrome in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 2005 Jul–Aug; 25(4): 226–32; discussion 33-4

  52. 52.

    Young RP, Hopkins R, Eaton TE. Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes. Eur Respir J 2007 Oct; 30(4): 616–22

  53. 53.

    Anthonisen NR, Skeans MA, Wise RA, et al. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Intern Med 2005 Feb 15; 142(4): 233–9

  54. 54.

    Jensen HH, Godtfredsen NS, Lange P, et al. Potential misclassification of causes of death from COPD. Eur Respir J 2006 Oct; 28(4): 781–5

  55. 55.

    McGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax 2007 May; 62(5): 411–5

  56. 56.

    Patil SP, Krishnan JA, Lechtzin N, et al. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003 May 26; 163(10): 1180–6

  57. 57.

    Schane RE, Woodruff PG, Dinno A, et al. Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease. J Gen Intern Med 2008 Nov; 23(11): 1757–62

  58. 58.

    Light RW, Merrill EJ, Despars JA, et al. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest 1985 Jan; 87(1): 35–8

  59. 59.

    Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry 2000 Dec; 15(12): 1090–6

  60. 60.

    Quint JK, Baghai-Ravary R, Donaldson GC, et al. Relationship between depression and exacerbations in COPD. Eur Respir J 2008 Jul; 32(1): 53–60

  61. 61.

    Incalzi RA, Chiappini F, Fuso L, et al. Predicting cognitive decline in patients with hypoxaemic COPD. Respir Med 1998 Mar; 92(3): 527–33

  62. 62.

    Bosley CM, Corden ZM, Rees PJ, et al. Psychological factors associated with use of home nebulized therapy for COPD. Eur Respir J 1996 Nov; 9(11): 2346–50

  63. 63.

    Yohannes AM, Roomi J, Baldwin RC, et al. Depression in elderly outpatients with disabling chronic obstructive pulmonary disease. Age Ageing 1998 Mar; 27(2): 155–60

  64. 64.

    Almagro P, Calbo E, Ochoa de Echaguen A, et al. Mortality after hospitalization for COPD. Chest 2002 May; 121(5): 1441–8

  65. 65.

    Cully JA, Graham DP, Stanley MA, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics 2006 Jul-Aug; 47(4): 312–9

  66. 66.

    Livermore N, Butler JE, Sharpe L, et al. Panic attacks and perception of inspiratory resistive loads in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008 Jul 1; 178(1): 7–12

  67. 67.

    Smoller JW, Pollack MH, Otto MW, et al. Panic anxiety, dyspnea, and respiratory disease: theoretical and clinical considerations. J Respir Crit Care Med 1996 Jul; 154(1): 6–17

  68. 68.

    Kunik ME, Veazey C, Cully JA, et al. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med 2008 Mar; 38(3): 385–96

  69. 69.

    Eiser N, Harte R, Spiros K, et al. Effect of treating depression on quality-of-life and exercise tolerance in severe COPD. COPD 2005 Jun; 2(2): 233–41

  70. 70.

    Argyropoulou P, Patakas D, Koukou A, et al. Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration 1993; 60(4): 216–20

  71. 71.

    Yohannes AM, Connolly MJ, Baldwin RC. A feasibility study of antidepressant drug therapy in depressed elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry 2001 May; 16(5): 451–4

  72. 72.

    Sirey JA, Raue PJ, Alexopoulos GS. An intervention to improve depression care in older adults with COPD. Int J Geriatr Psychiatry 2007 Feb; 22(2): 154–9

  73. 73.

    Murphy TF, Brauer AL, Eschberger K, et al. Pseudomonas aeruginosa in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008 Apr 15; 177(8): 853–60

  74. 74.

    Sethi S, Evans N, Grant BJ, et al. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002 Aug 15; 347(7): 465–71

  75. 75.

    Sethi S, Sethi R, Eschberger K, et al. Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007 Aug 15; 176(4): 356–61

  76. 76.

    Anzueto A, Sethi S, Martinez FJ. Exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007 Oct 1; 4(7): 554–64

  77. 77.

    Miravitlles M, Guerrero T, Mayordomo C, et al. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. The EOLO Study Group. Respiration 2000; 67(5): 495–501

  78. 78.

    White AJ, Gompertz S, Stockley RA. Chronic obstructive pulmonary disease: 6. The aetiology of exacerbations of chronic obstructive pulmonary disease. Thorax 2003 Jan; 58(1): 73–80

  79. 79.

    Donaldson GC, Seemungal TA, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002 Oct; 57(10): 847–52

  80. 80.

    Miravitlles M, Ferrer M, Pont A, et al. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax 2004 May; 59(5): 387–95

  81. 81.

    Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998 May; 157 (5 Pt 1): 1418–22

  82. 82.

    Aaron SD, Vandemheen KL, Clinch JJ, et al. Measurement of short-term changes in dyspnea and disease-specific quality of life following an acute COPD exacerbation. Chest 2002 Mar; 121(3): 688–96

  83. 83.

    Connors Jr AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT Investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996 Oct; 154 (4 Pt 1): 959–67

  84. 84.

    Kuzma AM, Meli Y, Meldrum C, et al. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008 May 1; 5(4): 567–71

  85. 85.

    Yohannes AM, Roomi J, Winn S, et al. The Manchester Respiratory Activities of Daily Living questionnaire: development, reliability, validity, and responsiveness to pulmonary rehabilitation. J Am Geriatr Soc 2000 Nov; 48(11): 1496–500

  86. 86.

    Jones PW, Quirk FH, Baveystock CM. The St George’s Respiratory Questionnaire. Respir Med 1991 Sep; 85Suppl. B: 25–31; discussion 3-7

  87. 87.

    Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005 Aug 10; 294(6): 716–24

  88. 88.

    Higgins MW, Enright PL, Kronmal RA, et al. Smoking and lung function in elderly men and women: the Cardiovascular Health Study. JAMA 1993 Jun 2; 269(21): 2741–8

  89. 89.

    Pelkonen M, Tukiainen H, Tervahauta M, et al. Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men. Thorax 2000 Sep; 55(9): 746–50

  90. 90.

    Taylor Jr DH, Hasselblad V, Henley SJ, et al. Benefits of smoking cessation for longevity. Am J Public Health 2002 Jun; 92(6): 990–6

  91. 91.

    Centers for Disease Control and Prevention. Cigarette smoking among adults: United States, 2007. MMWR Morb Mortal Wkly Rep 2008 Nov 14; 57(45): 1221–6

  92. 92.

    Centers for Disease Control and Prevention. Cigarette smoking among adults: United States, 2004. MMWR Morb Mortal Wkly Rep 2005 Nov 11; 54(44): 1121–4

  93. 93.

    Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008; (2): CD000165

  94. 94.

    Stratelis G, Molstad S, Jakobsson P, et al. The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD. Scand J Prim Health Care 2006 Sep; 24(3): 133–9

  95. 95.

    Tait RJ, Hulse GK, Waterreus A, et al. Effectiveness of a smoking cessation intervention in older adults. Addiction 2007 Jan; 102(1): 148–55

  96. 96.

    Hurt RD, Sachs DP, Glover ED, et al. A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med 1997 Oct 23; 337(17): 1195–202

  97. 97.

    Gonzales D, Rennard SI, Nides M, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA 2006 Jul 5; 296(1): 47–55

  98. 98.

    Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA 2006 Jul 5; 296(1): 56–63

  99. 99.

    Popkin MK. Exacerbation of recurrent depression as a result of treatment with varenicline. Am J Psychiatry 2008 Jun; 165(6): 774

  100. 100.

    Lasser KE, Boyd JW. Varenicline and smokers with mental illnesses. Lancet 2008 Oct 4; 372(9645): 1218–9

  101. 101.

    Hays JT, Ebbert JO. Varenicline for tobacco dependence. N Engl J Med 2008 Nov 6; 359(19): 2018–24

  102. 102.

    A clinical practice guideline for treating tobacco use and dependence: a US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA 2000 Jun 28; 283(24): 3244–54

  103. 103.

    Maguire CP, Ryan J, Kelly A, et al. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing 2000 May; 29(3): 264–6

  104. 104.

    Allen SC, Ragab S. Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age. Postgrad Med J 2002 Jan; 78(915): 37–9

  105. 105.

    Diggory P, Fernandez C, Humphrey A, et al. Comparison of elderly people’s technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial. BMJ 2001 Mar 10; 322(7286): 577–9

  106. 106.

    Chapman KR, Love L, Brubaker H. A comparison of breath-actuated and conventional metered-dose inhaler inhalation techniques in elderly subjects. Chest 1993 Nov; 104(5): 1332–7

  107. 107.

    Ho SF, O’Mahony MS, Steward JA, et al. Inhaler technique in older people in the community. Age Ageing 2004 Mar; 33(2): 185–8

  108. 108.

    Jarvis S, Ind PW, Shiner RJ. Inhaled therapy in elderly COPD patients; time for re-evaluation? Age Ageing 2007 Mar; 36(2): 213–8

  109. 109.

    Berry RB, Shinto RA, Wong FH, et al. Nebulizer vs spacer for bronchodilator delivery in patients hospitalized for acute exacerbations of COPD. Chest 1989 Dec; 96(6): 1241–6

  110. 110.

    Janssens W, VandenBrande P, Hardeman E, et al. Inspiratory flow rates at different levels of resistance in elderly COPD patients. Eur Respir J 2008 Jan; 31(1): 78–83

  111. 111.

    Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest 2005 Jan; 127(1): 335–71

  112. 112.

    Ofir D, Laveneziana P, Webb KA, et al. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008 Mar 15; 177(6): 622–9

  113. 113.

    Rennard S, Bantje T, Centanni S, et al. A dose-ranging study of indacaterol in obstructive airways disease, with a tiotropium comparison. Respir Med 2008 Jul; 102(7): 1033–44

  114. 114.

    Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007 Feb 22; 356(8): 775–89

  115. 115.

    Dahl R, Greefhorst LA, Nowak D, et al. Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001 Sep 1; 164(5): 778–84

  116. 116.

    Hanrahan JP, Hanania NA, Calhoun WJ, et al. Effect of nebulized arformoterol on airway function in COPD: results from two randomized trials. COPD 2008 Feb; 5(1): 25–34

  117. 117.

    Kottakis J, Cioppa GD, Creemers J, et al. Faster onset of bronchodilation with formoterol than with salmeterol in patients with stable, moderate to severe COPD: results of a randomized, double-blind clinical study. Can Respir J 2002 Mar-Apr; 9(2): 107–15

  118. 118.

    Handley DA, Senanayake CH, Dutczak W, et al. Biological actions of formoterol isomers. Pulm Pharmacol Ther 2002; 15(2): 135–45

  119. 119.

    Celli BR, Thomas NE, Anderson JA, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med 2008 Aug 15; 178(4): 332–8

  120. 120.

    Gupta P, O’Mahony MS. Potential adverse effects of bronchodilators in the treatment of airways obstruction in older people: recommendations for prescribing. Drugs Aging 2008; 25(5): 415–43

  121. 121.

    Anthonisen NR, Connett JE, Enright PL, et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002 Aug 1; 166(3): 333–9

  122. 122.

    Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 2008 Oct 9; 359(15): 1543–54

  123. 123.

    Vincken W, van Noord JA, Greefhorst AP, et al. Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. Eur Respir J 2002 Feb; 19(2): 209–16

  124. 124.

    Rabe KF, Magnussen H, Dent G. Theophylline and selective PDE inhibitors as bronchodilators and smooth muscle relaxants. Eur Respir J 1995 Apr; 8(4): 637–42

  125. 125.

    Barnes PJ. Theophylline in chronic obstructive pulmonary disease: new horizons. Proc Am Thorac Soc 2005; 2(4): 334–9; discussion 40-1

  126. 126.

    Culpitt SV, de Matos C, Russell RE, et al. Effect of theophylline on induced sputum inflammatory indices and neutrophil chemotaxis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002 May 15; 165(10): 1371–6

  127. 127.

    Rabe KF, Bateman ED, O’Donnell D, et al. Roflumilast: an oral anti-inflammatory treatment for chronic obstructive pulmonary disease. A randomised controlled trial. Lancet 2005 Aug 13–19; 366(9485): 563–71

  128. 128.

    Burge PS, Calverley PM, Jones PW, et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000 May 13; 320(7245): 1297–303

  129. 129.

    Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med 2000 Dec 28; 343(26): 1902–9

  130. 130.

    Vestbo J, Sorensen T, Lange P, et al. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 1999 May 29; 353(9167): 1819–23

  131. 131.

    Suissa S. Medications to modify lung function decline in chronic obstructive pulmonary disease: some hopeful signs. Am J Respir Crit Care Med 2008 Aug 15; 178(4): 322–3

  132. 132.

    Ernst P, Baltzan M, Deschenes J, et al. Low-dose inhaled and nasal corticosteroid use and the risk of cataracts. Eur Respir J 2006 Jun; 27(6): 1168–74

  133. 133.

    Garbe E, LeLorier J, Boivin JF, et al. Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids. Lancet 1997 Oct 4; 350(9083): 979–82

  134. 134.

    Hubbard RB, Smith CJ, Smeeth L, et al. Inhaled corticosteroids and hip fracture: a population-based case-control study. Am J Respir Crit Care Med 2002 Dec 15; 166 (12 Pt 1): 1563–6

  135. 135.

    Suissa S, Baltzan M, Kremer R, et al. Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care Med 2004 Jan 1; 169(1): 83–8

  136. 136.

    Ernst P, Gonzalez AV, Brassard P, et al. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 2007 Jul 15; 176(2): 162–6

  137. 137.

    The COMBIVENT Inhalation Solution Study Group. Routine nebulized ipratropium and albuterol together are better than either alone in COPD. Chest 1997 Dec; 112(6): 1514–21

  138. 138.

    Calverley PM, Boonsawat W, Cseke Z, et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003 Dec; 22(6): 912–9

  139. 139.

    van Noord JA, Aumann JL, Janssens E, et al. Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD. Eur Respir J 2005 Aug; 26(2): 214–22

  140. 140.

    Aaron SD, Vandemheen KL, Fergusson D, et al. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2007 Apr 17; 146(8): 545–55

  141. 141.

    Singh D, Brooks J, Hagan G, et al. Superiority of “triple” therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax 2008 Jul; 63(7): 592–8

  142. 142.

    Rabe KF, Timmer W, Sagkriotis A, et al. Comparison of a combination of tiotropium plus formoterol to salmeterol plus fluticasone in moderate COPD. Chest 2008 Aug; 134(2): 255–62

  143. 143.

    Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003 Jun 26; 348(26): 2618–25

  144. 144.

    Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999 Jun 24; 340(25): 1941–7

  145. 145.

    Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet 1999 Aug 7; 354(9177): 456–60

  146. 146.

    Shinkai M, Henke MO, Rubin BK. Macrolide antibiotics as immunomodulatory medications: proposed mechanisms of action. Pharmacol Ther 2008 Mar; 117(3): 393–405

  147. 147.

    Clement A, Tamalet A, Leroux E, et al. Long term effects of azithromycin in patients with cystic fibrosis: a double blind, placebo controlled trial. Thorax 2006 Oct; 61(10): 895–902

  148. 148.

    Nagai H, Shishido H, Yoneda R, et al. Long-term low-dose administration of erythromycin to patients with diffuse panbronchiolitis. Respiration 1991; 58(3–4): 145–9

  149. 149.

    Seemungal TA, Wilkinson TM, Hurst JR, et al. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med 2008 Dec 1; 178(11): 1139–47

  150. 150.

    Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987 Feb; 106(2): 196–204

  151. 151.

    Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006; (2): CD004403

  152. 152.

    Nouira S, Marghli S, Belghith M, et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet 2001 Dec 15; 358(9298): 2020–5

  153. 153.

    El Moussaoui R, Roede BM, Speelman P, et al. Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax 2008 May; 63(5): 415–22

  154. 154.

    Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 1980 Sep; 93(3): 391–8

  155. 155.

    Report of the Medical Research Council Working Party. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981 Mar 28; 1(8222): 681–6

  156. 156.

    Gorecka D, Gorzelak K, Sliwinski P, et al. Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia. Thorax 1997 Aug; 52(8): 674–9

  157. 157.

    Chaouat A, Weitzenblum E, Kessler R, et al. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients. Eur Respir J 1999 Nov; 14(5): 1002–8

  158. 158.

    Drummond MB, Blackford AL, Benditt JO, et al. Continuous oxygen use in nonhypoxemic emphysema patients identifies a high-risk subset of patients: retrospective analysis of the National Emphysema Treatment Trial. Chest 2008 Sep; 134(3): 497–506

  159. 159.

    Croxton TL, Bailey WC. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. Am J Respir Crit Care Med 2006 Aug 15; 174(4): 373–8

  160. 160.

    Ram FS, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004; (3): CD004104

  161. 161.

    Balami JS, Packham SM, Gosney MA. Non-invasive ventilation for respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease in older patients. Age Ageing 2006 Jan; 35(1): 75–9

  162. 162.

    Rozzini R, Sabatini T, Trabucchi M. Non-invasive ventilation for respiratory failure in elderly patients. Age Ageing 2006 Sep; 35(5): 546–7

  163. 163.

    Casanova C, Celli BR, Tost L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest 2000 Dec; 118(6): 1582–90

  164. 164.

    Clini E, Sturani C, Rossi A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J 2002 Sep; 20(3): 529–38

  165. 165.

    Tsolaki V, Pastaka C, Karetsi E, et al. One-year noninvasive ventilation in chronic hypercapnic COPD: effect on quality of life. Respir Med 2008 Jun; 102(6): 904–11

  166. 166.

    Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med 1999 Mar 2; 130(5): 397–403

  167. 167.

    Nichol KL, Margolis KL, Wuorenma J, et al. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994 Sep 22; 331(12): 778–84

  168. 168.

    Alfageme I, Vazquez R, Reyes N, et al. Clinical efficacy of anti-pneumococcal vaccination in patients with COPD. Thorax 2006 Mar; 61(3): 189–95

  169. 169.

    Granger R, Walters J, Poole PJ, et al. Injectable vaccines for preventing pneumococcal infection in patients with chronic obstructive pulmonary disease. Cochrane Database Syst 2006; (4): CD001390

  170. 170.

    Moberley SA, Holden J, Tatham DP, et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst 2008; (1): CD000422

  171. 171.

    Jackson LA, Neuzil KM, Yu O, et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med 2003 May 1; 348(18): 1747–55

  172. 172.

    Furumoto A, Ohkusa Y, Chen M, et al. Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease. Vaccine 2008 Aug 5; 26(33): 4284–9

  173. 173.

    Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006 Jun 15; 173(12): 1390–413

  174. 174.

    Paz-Diaz H, Montes de Oca M, Lopez JM, et al. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007 Jan; 86(1): 30–6

  175. 175.

    Guell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest 2000 Apr; 117(4): 976–83

  176. 176.

    Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2008 Dec 16; 149(12): 869–78

  177. 177.

    Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med 2008 Jun; 102(6): 819–24

  178. 178.

    Takigawa N, Tada A, Soda R, et al. Comprehensive pulmonary rehabilitation according to severity of COPD. Respir Med 2007 Feb; 101(2): 326–32

  179. 179.

    Baltzan MA, Kamel H, Alter A, et al. Pulmonary rehabilitation improves functional capacity in patients 80 years of age or older. Can Respir J 2004 Sep; 11(6): 407–13

  180. 180.

    Couser Jr JI, Guthmann R, Hamadeh MA, et al. Pulmonary rehabilitation improves exercise capacity in older elderly patients with COPD. Chest 1995 Mar; 107(3): 730–4

  181. 181.

    Di Meo F, Pedone C, Lubich S, et al. Age does not hamper the response to pulmonary rehabilitation of COPD patients. Age Ageing 2008 Sep; 37(5): 530–5

  182. 182.

    Constans T, Bacq Y, Brechot JF, et al. Protein-energy malnutrition in elderly medical patients. J Am Geriatr Soc 1992 Mar; 40(3): 263–8

  183. 183.

    Payette H, Coulombe C, Boutier V, et al. Weight loss and mortality among free-living frail elders: a prospective study. J Gerontol 1999 Sep; 54(9): M440–5

  184. 184.

    Openbrier DR, Irwin MM, Rogers RM, et al. Nutritional status and lung function in patients with emphysema and chronic bronchitis. Chest 1983 Jan; 83(1): 17–22

  185. 185.

    Chailleux E, Laaban JP, Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory. Chest 2003 May; 123(5): 1460–6

  186. 186.

    Landbo C, Prescott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999 Dec; 160(6): 1856–61

  187. 187.

    Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004 Mar 4; 350(10): 1005–12

  188. 188.

    Payette H, Boutier V, Coulombe C, et al. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. J Am Diet Assoc 2002 Aug; 102(8): 1088–95

  189. 189.

    Efthimiou J, Fleming J, Gomes C, et al. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1988 May; 137(5): 1075–82

  190. 190.

    Rogers RM, Donahoe M, Costantino J. Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease: a randomized control study. Am Rev Respir Dis 1992 Dec; 146(6): 1511–7

  191. 191.

    Whittaker JS, Ryan CF, Buckley PA, et al. The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients. Am Rev Respir Dis 1990 Aug; 142(2): 283–8

  192. 192.

    Schols AM, Slangen J, Volovics L, et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998 Jun; 157 (6 Pt 1): 1791–7

  193. 193.

    Schols AM, Broekhuizen R, Weling-Scheepers CA, et al. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005 Jul; 82(1): 53–9

  194. 194.

    Vestbo J, Prescott E, Almdal T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006 Jan 1; 173(1): 79–83

  195. 195.

    Marti S, Munoz X, Rios J, et al. Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy. Eur Respir J 2006 Apr; 27(4): 689–96

  196. 196.

    Schols AM, Soeters PB, Mostert R, et al. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease: a placebo-controlled randomized trial. Am J Respir Crit Care Med 1995 Oct; 152 (4 Pt 1): 1268–74

  197. 197.

    Creutzberg EC, Wouters EF, Mostert R, et al. A role for anabolic steroids in the rehabilitation of patients with COPD? A double-blind, placebo-controlled, randomized trial. Chest 2003 Nov; 124(5): 1733–42

  198. 198.

    Yeh SS, Lovitt S, Schuster MW. Pharmacological treatment of geriatric cachexia: evidence and safety in perspective. J Am Med Dir Assoc 2007 Jul; 8(6): 363–77

  199. 199.

    Goodridge D, Lawson J, Duggleby W, et al. Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life. Respir Med 2008 Jun; 102(6): 885–91

  200. 200.

    Claessens MT, Lynn J, Zhong Z, et al. Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 2000 May; 48(5 Suppl.): S146–53

  201. 201.

    Edmonds P, Karlsen S, Khan S, et al. A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer. Palliat Med 2001 Jul; 15(4): 287–95

  202. 202.

    Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax 2000 Dec; 55(12): 1000–6

  203. 203.

    Lanken PN, Terry PB, Delisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008 Apr 15; 177(8): 912–27

  204. 204.

    Shee CD, Green M. Non-invasive ventilation and palliation: experience in a district general hospital and a review. Palliat Med 2003 Jan; 17(1): 21–6

  205. 205.

    Booth S, Kelly MJ, Cox NP, et al. Does oxygen help dyspnea in patients with cancer? Am J Respir Crit Care Med 1996 May; 153(5): 1515–8

  206. 206.

    Jennings AL, Davies AN, Higgins JP, et al. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev 2001; (4): CD002066

  207. 207.

    Kara M, Mirici A. Loneliness, depression, and social support of Turkish patients with chronic obstructive pulmonary disease and their spouses. J Nurs Scholarsh 2004; 36(4): 331–6

  208. 208.

    Seamark DA, Blake SD, Seamark CJ, et al. Living with severe chronic obstructive pulmonary disease (COPD): perceptions of patients and their carers. An interpretative phenomenological analysis. Palliat Med 2004 Oct; 18(7): 619–25

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Dr Marcia L. Erbland.

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Nazir, S.A., Erbland, M.L. Chronic Obstructive Pulmonary Disease. Drugs Aging 26, 813–831 (2009). https://doi.org/10.2165/11316760-000000000-00000

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Smoking Cessation
  • Palliative Care
  • Chronic Obstructive Pulmonary Disease Patient
  • Salmeterol