Screening for chronic obstructive pulmonary disease in elderly subjects with dyspnoea and/or reduced exercise tolerance – A hospital based cross sectional study

Background: Chronic obstructive pulmonary disease (COPD) is a very common lung disease most often related to history of smoking. It becomes more prevalent with increasing age but remains under-diagnosed and under-treated in the elderly population. Under diagnosis of COPD is universal in elderly patients because of multiple pathology, difficulty with measurement of lung function, under-reporting of symptoms and reduced perception of dyspnoea. However the screening of the elderly (age >60 years) is not performed routinely even when they are symptomatic. Objective: The study was undertaken to screen elderly subjects with dyspnoea and/or reduced exercise tolerance for COPD. Study design: A cross sectional hospital based study. Methods: A total of 1000 elderly subjects were screened for COPD using standard spirometry as per GOLD guidelines. Diagnostic evaluation and classification of patients as “no COPD”, “new COPD” and “known COPD” were done by panel of experts which included a Pulmonologist, Cardiologist, General Physician and Physiotherapist. Subjects were categorized as mild, moderate, severe and very severe COPD based on FEV1 (forced expiratory volume in 1st sec) values. Results: Of the total 1000 elderly participants screened, 596 (59.6%) were classified as having no COPD, 228 (22.8%) with new COPD and 176 (17.6%) with known COPD. Among the total 228 of new COPD patients 27 (11.8%), 176 (77.4%), 5 (2.1%) and 20 (8.7%) were having mild, moderate, severe and very severe COPD respectively as per GOLD guidelines. Similarly of the total 176 subjects with known COPD, 9 (5.1%), 136 (77.3%), 0 (0%) and 31 (17.6%) were having mild, moderate, severe and very severe COPD respectively. Conclusion: An active screening for COPD in elderly subjects with dyspnoea or reduced exercise tolerance leads to diagnoses of substantially more new patients with COPD