Arterial blood gases in elderly persons with chronic obstructive pulmonary disease (COPD)

With the increasing number of elderly people in developed countries, physicians are often confronted with patients whose arterial oxygen tension, PaO2, is lower than that of normal young adults. The normal values predicted in the literature for very old individuals are generally extrapolated from younger subjects. The purpose of the present study was to obtain PaO2 values from a large population of elderly subjects with normal and obstructive ventilatory function. We measured arterial blood gases in 274 subjects, aged 65-100 yrs (mean 82 yrs), with chronic bronchitis and moderate airways obstruction (mean forced expiratory volume in one second (FEV1), 53% pred). Mean PaO2 was 10.0 +/- 1.4 kPa (75.2 +/- 10.8 mmHg) and mean arterial carbon dioxide tension (PaCO2) was 5.4 +/- 0.8 kPa (40.5 +/- 6.1 mmHg). Both PaO2 and PaCO2 were independent of age. Blood gas abnormalities were associated with airways obstruction: PaO2 was positively correlated to FEV1 and PaCo2 was negatively correlated to FEV1. PaO2 was 10.8 +/- 1.4 kPa (81.5 +/- 10.7 mmHg) in the patients with FEV1 > or = 90% predicted versus 9.5 +/- 1.3 kPa (71.5 +/- 10.1 mmHg) in those with FEV1 < or = 35% pred. These findings suggest that the predicted PaO2 extrapolated from younger normal values are often erroneously underestimated. It is probably more accurate to accept as normal a PaO2 of 10.6-11.3 kPa (80-85 mmHg) for all subjects over 65 yrs, irrespective of their age.

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