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Determinants of prognosis of COPD in the elderly: mucus hypersecretion, infections, cardiovascular comorbidity

¹ Dept of Respiratory Physiology, Catholic University, Rome, Italy, ² Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark, ³ Dept of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark, ⁴ Dept of Public Health Sciences, King's College, University of London, London, UK

CORRESPONDENCE: R. Pistelli, Dept of Respiratory Physiology, Catholic University, Via Moscati, 31, 00168 Rome, Italy. Fax: 39 063054641. E-mail: columbus.fpr@linet.it

Keywords: cardiovascular comorbidity, elderly, mucus hypersecretion, respiratory infections

Received: April 12, 2002
In this paper, the authors update the present knowledge about three risk factors for the prognosis of chronic obstructive pulmonary disease (COPD), which may be particularly relevant in elderly people: mucus hypersecretion, respiratory infections, and cardiovascular comorbidity. Chronic mucus hypersecretion (CMH) is a common respiratory symptom in old age, the relevance of which is analysed on the basis of data collected during the first three rounds of the Copenhagen City Heart Study. In subjects aged 65 yrs, CMH was a strong predictor of the incidence of respiratory infections in a 10-yr follow-up period and it was also a strong predictor of death from COPD (relative risk=2.5). However, CMH was associated with consistently lower forced expiratory volume in one second (FEV₁) values, but not with an accelerated decline of FEV₁ in this sample of an elderly population.

Acute respiratory infections (ARI) are extremely common at all ages, mostly mild self-limiting illnesses at a young age, but severe often fatal illnesses in elderly people already affected by a chronic disease such as COPD. This paper summarises the present knowledge about aetiology, pathology, prognostic relevance, and prevention of ARI. Furthermore, the areas in which further research is needed are listed. Clinical cohort studies clearly support the relevance of cardiovascular comorbidity for the short- and long-term prognosis of elderly subjects affected by severe COPD.

In this paper, the recently demonstrated association between particulate air pollution and cardiovascular events is reported to suggest the presence of an extremely susceptible cluster of elderly subjects in the population identified by the copresence of chronic obstructive pulmonary disease and cardiovascular comorbidity.