The Curbsiders Internal Medicine Podcast #408 COPD in Older Adults with Leah Witt, MD & Amber Lanae Martirosov, PharmD
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Sep 18, 2023 Learn about COPD in older adults with expert guests Dr. Leah Witt and Dr. Amber Lanae Martirosov. Topics covered include COPD diagnosis and classification, inhaler misuse and cost, and the impact of COVID-19 on pulmonary care. They also discuss the challenges of medication cost and coverage, and the need for standardized use of maintenance inhalers.
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COPD Is A Clinical Diagnosis Not Just Spirometry
- COPD is a clinical diagnosis requiring chronic symptoms, exposure history, and confirmatory post-bronchodilator spirometry (FEV1/FVC < 0.7).
- Spirometry alone is insufficient; interpret results in the clinical context including exposures and symptoms.
Stage With ABE Not Just FEV1
- Use the GOLD ABE framework (A, B, E) to stage COPD, prioritizing symptoms and exacerbation history over spirometry.
- Treat group E promptly with long-acting dual bronchodilators (LAMA+LABA) rather than relying on spirometry grade alone.
Age Alters Spirometry Interpretation
- Aging changes lungs and chest wall producing more obstructive-appearing spirometry, raising over-diagnosis risk in older adults.
- Consider lower limit of normal rather than strict 0.7 cutoff when age-related changes may mislead.