1. Examining the Effects of Age on Health Outcomes of Chronic Obstructive Pulmonary Disease: Results From the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate Endpoints Cohorts
- Author
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Chu-Lin Tsai, Hassan Al-Azzawi, Aladin M. Boriek, Dawn L. DeMeo, Robert A. Wise, Christina C. Kao, Nicholas Locantore, Amit D. Parulekar, Marilyn G. Foreman, Elizabeth A. Regan, Carlos H. Martinez, Mustafa A. Atik, Nicola A. Hanania, Ali Mohsin, Abebaw Mengistu Yohannes, Barry J. Make, and Laura Elizabeth Wiener
- Subjects
Male ,medicine.medical_specialty ,Exacerbation ,Comorbidity ,Risk Assessment ,Severity of Illness Index ,Article ,Statistics, Nonparametric ,Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Forced Expiratory Volume ,Internal medicine ,Severity of illness ,Odds Ratio ,Prevalence ,medicine ,Humans ,Genetic Predisposition to Disease ,Longitudinal Studies ,030212 general & internal medicine ,General Nursing ,Aged ,Retrospective Studies ,COPD ,business.industry ,Health Policy ,Age Factors ,General Medicine ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,Obstructive lung disease ,Survival Rate ,030228 respiratory system ,Cohort ,Disease Progression ,Quality of Life ,Physical therapy ,Female ,Geriatrics and Gerontology ,business ,Biomarkers ,Cohort study - Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) and its associated comorbidities increase with age. However, little is understood about differences in the disease in patients over 65 years of age compared with younger patients.To determine disease characteristics of COPD and its impact in older patients compared with younger patients.We examined baseline characteristics of patients with COPD (global obstructive lung disease stage II-IV) in 2 large cohorts: Genetic Epidemiology of COPD Study (COPDGene) and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared demographics, indices of disease severity, prevalence of comorbidities, exacerbation frequency, and quality of life scores in patients ≥65 years of age vs patients65 years of age. We also tested for associations of age with disease characteristics and health outcomes.In the COPDGene cohort, older patients (n = 1663) had more severe disease as measured by forced expiratory volume in 1 second (1.22 vs 1.52 L, P .001), use of long-term oxygen therapy (35% vs 22%, P .001), 6-minute walk distance (355 vs 375 m, P .001), and radiographic evidence of emphysema (14% vs 8%, P .001) and air trapping (47% vs 36%, P .001) and were more likely to have comorbidities compared with younger patients (n = 2027). Similarly, in the ECLIPSE cohort, older patients (n = 1030) had lower forced expiratory volume in 1 second (1.22 vs 1.34 L, P .001), greater use of long-term oxygen therapy (7% vs 5%, P = .02), shorter 6- minute walk distance (360 vs 389 m, P .001), and more radiographic evidence of emphysema (17% vs 14%, P = .009) than younger patients (n = 1131). In adjusted analyses of both cohorts, older age was associated with decreased frequency of exacerbations [odds ratio = 0.52, 95% confidence interval (CI) = 0.43-0.64 in COPDGene, odds ratio = 0.79, 95% CI = 0.64-0.99 in ECLIPSE] and a better quality of life (lower St. Georges respiratory questionnaire score) (β = -8.7, 95% CI = -10.0 to -7.4 in COPDGene, β = -4.4, 95% CI = -6.1 to -3.2 in ECLIPSE).Despite greater severity of illness, older patients with COPD had better quality of life and reported fewer exacerbations than younger patients. Although this observation needs to be explored further, it may be related to the fact that older patients change their expectations and learn to adapt to their disease.
- Published
- 2017
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