PULMONARY DISEASES AFFECTING THE OLDER PATIENT IN REHABILITATION
As noted, older patients with chronic lung disease often hnd themselves trapped in a recurring cycle of hospitalizations, increasing physical disability, and progressive inactivity. This portion of the chapter will review four common chronic lung diseases affecting the older adult, providing a brief overview of their evaluation and management and emphasizing specihc factors that may be of use to the rehabilitation practitioner.
Chronic Obstructive Pulmonary Disease
The burden of COPD has increased steadily worldwide over the last three decades despite welcome trends in reduced tobacco consumption. It has become increasingly a disease of the elderly, with rising prevalence in the sixth decade and beyond.24,25 As noted earlier, COPD is the third most common cause of death in the United States, and by the year 2020 it is projected to be the fourth leading cause of disability.26 Indeed, it has been estimated that adults with COPD have a 10-fold higher risk of disability than age-matched members of the general population,27 and are more disabled than those afflicted by other common chronic diseases like heart disease and diabetes.28 COPD is a leading cause of hospitalization in the United States, accounting for at least 20% of hospitalizations in patients aged 65 and older.29 Finally, and importantly, physical inactivity has emerged as a strong independent risk factor for poor outcome in COPD, including mortality.30 Unlike factors such as past tobacco abuse or comorbid heart disease, physical inactivity in patients with COPD is eminently modifiable, a fact which has appropriately placed rehabilitation efforts at the center of the campaign to better manage this disease.
COPD is an umbrella term encompassing conditions marked by airflow obstruction with varying degrees of reversibility. Here, we will focus on the subsets of emphysema and chronic bronchitis, typically deemed the “irreversible” phenotype(s) of COPD, as asthma will be addressed in the next section. It should be acknowledged that an overlap exists between the obstructive disease phenotypes, and that the dichotomy of “asthma vs. COPD” is likely an oversimplification, particularly in the older population.