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
Journal
Journal of the American Medical Directors Association
Journal Volume
18
Journal Issue
12
Pages
1063-1068
Date Issued
2017
Author(s)
Parulekar A.D.
Martinez C.
Locantore N.
Atik M.
Yohannes A.M.
Kao C.C.
Al-Azzawi H.
Mohsin A.
Wise R.A.
Foreman M.G.
Demeo D.L.
Regan E.A.
Make B.J.
Boriek A.M.
Wiener L.E.
Hanania N.A.
Abstract
Rationale 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. Objectives To determine disease characteristics of COPD and its impact in older patients compared with younger patients. Methods 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 patients <65 years of age. We also tested for associations of age with disease characteristics and health outcomes. Results 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). Conclusions 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. ? 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine
SDGs
Other Subjects
oxygen; biological marker; adult; age; aged; Article; asthma; chronic obstructive lung disease; clinical outcome; cohort analysis; comorbidity; congestive heart failure; controlled study; coronary artery disease; diabetes mellitus; disease exacerbation; disease severity; emphysema; female; forced expiratory volume; frequency; gastroesophageal reflux; genetic epidemiology; human; hypertension; longitudinal study; major clinical study; male; middle aged; oxygen therapy; prevalence; prospective study; quality of life; six minute walk test; St. George Respiratory Questionnaire; age; chronic obstructive lung disease; comparative study; genetic predisposition; genetics; nonparametric test; odds ratio; physiology; predictive value; prognosis; quality of life; retrospective study; risk assessment; severity of illness index; survival rate; Age Factors; Aged; Biomarkers; Cohort Studies; Comorbidity; Disease Progression; Female; Forced Expiratory Volume; Genetic Predisposition to Disease; Humans; Longitudinal Studies; Male; Middle Aged; Odds Ratio; Predictive Value of Tests; Prevalence; Prognosis; Pulmonary Disease, Chronic Obstructive; Quality of Life; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Rate
Type
journal article