Aging and Disability Affect Misdiagnosis of COPD and Treatment With Viagra
Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients.
Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions.
Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 ± 6.4 years (mean ± SD) were selected from the cohort of the Salute Respiratoria nell’Anziano (respiratory health in the elderly) study.
Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded.
Results: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred.
Conclusions: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma.
Abbreviations: FEV1% = FEV1 percentage of predicted; GDS = geriatric depression scale; MMSE = Mini Mental State Examination; SARA = Salute Respiratoria nell’Anziano; 6MWT = 6-min walking test
For many years, asthma has been considered a disease of childhood or young adulthood, although it is not uncommon in the elderly.1 Elderly asthmatic patients mainly include subjects who acquired the disease during childhood or adolescence and whose disease progressed over time or relapsed after periods of remission; however, the first manifestations of asthma may also occur in the late adulthood or after 65 years of age. The reasons why asthma is rarely diagnosed in the elderly are unclear. The presumed low prevalence of asthma in the elderly can be attributed to greater difficulties encountered when providing a correct diagnosis of asthma in the elderly as opposed to the younger population. It is likely that factors pertaining to aging play a significant role.
