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Managing Older Patients with Coexistent Asthma and Chronic Obstructive Pulmonary Disease

Diagnostic and Therapeutic Challenges

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Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases, especially among older people. These conditions are associated with a significant and increasing disease burden. The diagnosis and management of asthma and COPD in older populations are complex, and consequently clinicians are faced with many therapeutic and diagnostic challenges. Both aging and obstructive airway diseases are associated with complex co-morbidities and these coexisting illnesses confound management. Moreover, the age-related physiological changes that occur in the lungs may lead to airflow limitation, and this may be difficult to distinguish from an active disease state. In practice, management of asthma and COPD is informed by disease-specific clinical practice guidelines; however, most older people with these conditions are excluded from clinical trials that are designed to inform practice, creating major evidence gaps. Furthermore, seldom do clinical practice guidelines consider the complexities of management in older populations. The problems experienced by older people are complex and multifactorial and our approach to management must reflect these challenges. Opportunities exist to improve the management and outcomes for older people with obstructive airway disease and there is an urgent need for clinical trials to test management approaches in this population; current research must consider the challenges and evidence gaps that exist.

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Acknowledgments

Dr. Vanessa McDonald has been reimbursed for participation in symposia funded by AstraZeneca, Boehinger Ingelheim, GlaxoSmithKline and Novartis. She has participated in studies funded by GlaxoSmithKline and Novartis. Professor Isabel Higgins has no conflict of interest to declare. Professor Peter Gibson holds an NHMRC Practitioner Fellowship. He has been reimbursed for participation in symposia funded by AstraZeneca, Boehinger Ingelheim, GlaxoSmithKline and Novartis. He has participated in studies funded by Pharmaxis and GlaxoSmithKline.

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Authors and Affiliations

  1. Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, NSW, Australia

    Vanessa M. McDonald & Peter G. Gibson

  2. School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia

    Vanessa M. McDonald & Peter G. Gibson

  3. School of Nursing and Midwifery, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia

    Vanessa M. McDonald & Isabel Higgins

  4. Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia

    Vanessa M. McDonald & Peter G. Gibson

  5. Woolcock Institute of Medical Research, Sydney, NSW, Australia

    Peter G. Gibson

  6. Level 2 West Wing, Hunter Medical Research Institute, Locked bag 1000, New Lambton, NSW, 2305, Australia

    Peter G. Gibson

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  1. Vanessa M. McDonald
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Correspondence to Peter G. Gibson.

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McDonald, V.M., Higgins, I. & Gibson, P.G. Managing Older Patients with Coexistent Asthma and Chronic Obstructive Pulmonary Disease. Drugs Aging 30, 1–17 (2013). https://doi.org/10.1007/s40266-012-0042-z

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