Advertisement

Pulmonary Disease

  • James R. WebsterJr.
  • Thomas Cain

Abstract

The opportunities provided by clinical presentations of an older patient with pulmonary problems are both challenging and rewarding, often demonstrating classic examples of the geriatric paradigm, with interaction of primary, secondary, and tertiary risk factors. The primary risk factors are the changes of expected/anticipated aging, the secondary factors relate to particular disease processes, and the tertiary factors are the modifiable aspects of the patient’s life and illness, for example, exercise, diet, psychological issues, alcohol use, poverty, and, in particular for lung disease, cigarettes.

Keywords

Chronic Obstructive Pulmonary Disease Obstructive Sleep Apnea Pulmonary Embolism Smoking Cessation Chronic Obstructive Pulmonary Disease Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Connolly MJ, Crowley J J, Charan NB, et al. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax. 1992; 47: 410–413.PubMedCrossRefGoogle Scholar
  2. 2.
    Krumpe PE, Knudson RJ, Parsons G, et al. The aging respiratory system. Clin Geriatr Med. 1985; 1: 143–175.PubMedGoogle Scholar
  3. 3.
    Petty TL. It’s never too late to stop smoking, but how old are your lungs? JAMA. 1993; 269: 27–85.Google Scholar
  4. 4.
    Ibbotson SH, Tate GH, Davies JA. Thrombin activity by intrinsic activation of plasma in vitro acceleration with increasing age of the donor. Thromb Haemost. 1992; 67: 377–380.PubMedGoogle Scholar
  5. 5.
    Hirsch J. Pulmonary embolism in the elderly. Cardiol Clin. 1991; 9: 457–474.Google Scholar
  6. 6.
    PIOPED Investigators. Valve of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990; 263: 2753–2759.CrossRefGoogle Scholar
  7. 7.
    McFarlane MJ, Imperiale TF. Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism. Am J Med. 1994; 41: 57–62.CrossRefGoogle Scholar
  8. 8.
    Mclntyre K, Sasahara AA. The ratio of pulmonary arterial pressure to pulmonary vascular obstruction. Chest. 1977; 71: 692–698.CrossRefGoogle Scholar
  9. 9.
    White RH, McGahan JP, Daschbach MM, et al. Diagnosis of deep vein thrombosis using duplex ultrasound. Ann Intern Med. 1989; 111: 297–304.PubMedGoogle Scholar
  10. 10.
    Kniffin WD, Baron JA, Barrett J, et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med. 1994; 154: 861–866.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldhaber SZ, Kessler CM, Heit J, et al. Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet. 1988; 2: 293–298.PubMedCrossRefGoogle Scholar
  12. 12.
    Clagett GP, Anderson FA, Levine MN, et al. Prevention of venous thromboembolism. Chest. 1992; 102: 3915–4075.Google Scholar
  13. 13.
    Wade JF, King TE. Infiltrative and interstitial lung disease in the elderly patient. Clin Chest Med. 1993; 14: 501–521.PubMedGoogle Scholar
  14. 14.
    Schwartz MF, King TE, eds. Interstitial Lung Disease. Toronto: B.C. Deeber; 1988.Google Scholar
  15. 15.
    Winterbauer RH. The treatment of ideopathic pulmonary fibrosis. Chest 1991; 100: 233–240.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenow EC III, Meyers JL, Swensen SJ, Pisami RJ. Drug induced pulmonary disease: an update. Chest. 1992; 102: 239–250.PubMedCrossRefGoogle Scholar
  17. 17.
    Feinsilver SH, Hertz G. Sleep in the elderly. Clin Chest Med. 1993; 14 (3): 405–411.PubMedGoogle Scholar
  18. 18.
    Hoch CC, Reynolds CF III, Monk TN, et al. Comparison of sleep disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep. 1990; 13 (6): 502–511.PubMedGoogle Scholar
  19. 19.
    Ancoli-Israel S, Cox T. Are breathing disturbances in elderly equivalent to sleep apnea syndrome. Sleep. 1994; 17 (l): 77–83.Google Scholar
  20. 20.
    Tousignant P, Cosio MG, Levy RD, et al. Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep. 1994; 17 (l): 52–60.Google Scholar
  21. 21.
    Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977; 1: 1645–1648.PubMedCrossRefGoogle Scholar
  22. 22.
    Holleman DR, Simel DL, Goldberg JS. Diagnosis of obstructive airways disease from the clinical examination. J Gen Intern Med. 1993; 8: 63–68.PubMedCrossRefGoogle Scholar
  23. 23.
    Enright PL, Kronmal RA, Higgins MW, et al. Prevalence and correlates of respiratory symptoms and disease in the elderly. Chest. 1994; 106: 827–834.PubMedCrossRefGoogle Scholar
  24. 24.
    Anthonisen NR. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. Rev Respir Dis. 1989; 140: 595–599.Google Scholar
  25. 25.
    Rimer BK, Orleans CT, Keintz MK, et al. The older smokers: status, challenges and opportunities for intervention. Chest. 1990; 97: 547–553.PubMedCrossRefGoogle Scholar
  26. 26.
    Orleans CT, Jepson C, Resch N, et al. Quitting motives and barriers among older smokers. Cancer Suppl. 1994; 74: 2055–2061.CrossRefGoogle Scholar
  27. 27.
    Higgins MW, Enright PL, Kronmal RA, et al. Smoking and lung function in elderly men and women: the cardiovascular health study. JAMA. 1993; 269: 2741–2748.PubMedCrossRefGoogle Scholar
  28. 28.
    Daniels S, Meuleman J. Importance of assessment of me-tered-dose inhaler technique in the elderly. J Am Geriatric Soc. 1994; 42: 82–84.Google Scholar
  29. 29.
    Kerstjens HAM, Brand PLP, Hughes MD, et al. A comparison of bronchodilator therapy with or without inhaled corticosteroid therapy for obstructive airways disease. N Engl J Med. 1992; 327: 1413–1419.PubMedCrossRefGoogle Scholar
  30. 30.
    O’Driscoll BR, Kalra S, Wilson M. Double-blind trial of steroid tapering in acute asthma. Lancet. 1993; 6 (341): 324–327.CrossRefGoogle Scholar
  31. 31.
    Shannon M. Predictors of major toxicity after the theophyllin overdose. Ann Intern Med. 1993; 119: 1161–1167.PubMedGoogle Scholar
  32. 32.
    Isada CM, Stollar JK. Chronic bronchitis: role of antibiotics. In: Niederman MS, Sarosi GA, Glassroth J, eds. Respiratory Infections. Philadelphia: WB Saunders; 1994.Google Scholar
  33. 33.
    Boysen PG, Block AJ, Wynne JW, et al. Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chest. 1979; 76: 536–542.PubMedCrossRefGoogle Scholar
  34. 34.
    Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy and hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med. 1980; 93: 391–398.Google Scholar
  35. 35.
    Swinburn CR, Mould H, Stone TN, et al. Symptomatic benefit of supplemental oxygen in hypoxemic patients with chronic lung disease. Am Rev Respir Dis. 1991; 143: 913–915.PubMedGoogle Scholar
  36. 36.
    Dales RE, Dionne G, Leech JA, Lunau M, Schweitzer I. Preoperative prediction of pulmonary complications following thoracic surgery. Chest. 1993; 104: 155–159.PubMedCrossRefGoogle Scholar
  37. 37.
    Zibrak JD, O’Donnell CR. Indications for preoperative pulmonary function testing. Indications for preoperative pulmonary function testing. Clin Chest Med. 1993; 14 (2): 227–236.PubMedGoogle Scholar
  38. 38.
    Hall JC, Tarala R, Harris J, Tapper J, Christiansen K. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet. 1991; 337: 953–956.PubMedCrossRefGoogle Scholar
  39. 39.
    Wasylak TJ, Abbot FV, English MJM, et al. Reduction of postoperative morbidity following patient controlled morphine. Can J Anaesth. 1990; 37 (7): 726–731.PubMedCrossRefGoogle Scholar
  40. 40.
    Egbert AM, Parks LH, Short LM, et al. Randomized trial of postoperative patient-controlled analysis versus intramuscular narcotics in frail elderly men. Arch Intern Med. 1990; 150: 1897–1903.PubMedCrossRefGoogle Scholar
  41. 41.
    Thomas DR, Ritchie CS. Preoperative assessment of older adults. J Am Geriatr Soc. 1995; 43: 811–821.PubMedGoogle Scholar
  42. 42.
    Clarke DE, Goldstein MK, Raffin TA. Ethical dilemmas in the critically ill elderly. Clin Geriatr Med. 1994; 10: 91–101.PubMedGoogle Scholar
  43. 43.
    Pesau B, Falger S, Berger E, et al. Influence of age on outcome of mechanically ventilated patients in an intensive care unit. Crit Care Med. 1992; 20: 489–492.PubMedCrossRefGoogle Scholar
  44. 44.
    Heuser MD, Case LD, Ettinger WH. Mortality in intensive care patients with respiratory disease, is age important? Arch Intern Med. 1992; 152: 1683–1688.PubMedCrossRefGoogle Scholar
  45. 45.
    Krieger BP. Respiratory failure in the elderly. Clin Geriatr Med 1994; 10: 103–119.PubMedGoogle Scholar
  46. 46.
    Hanson LC, Danic M. Use of life sustaining care for the elderly. J Am Geriatr Soc. 1991; 39: 772–777.PubMedGoogle Scholar
  47. 47.
    Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of illness disease classification system. Crit Care Med. 1985; 13: 818–829.PubMedCrossRefGoogle Scholar
  48. 48.
    Cohen IL, Lombrinos J, Fein A. Mechanical ventilation for the elderly patient in intensive care: incremental charges and benefits. JAMA. 1993; 269: 1025–1029.PubMedCrossRefGoogle Scholar
  49. 49.
    Pearlman RA. Variability in physician estimates of survival for acute respiratory failure in chronic obstructive pulmonary disease. Chest. 1987; 91: 515–521.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • James R. WebsterJr.
  • Thomas Cain

There are no affiliations available

Personalised recommendations