The Prevalence and Type of Chronic Obstructive Bronchopulmonary Disease in Very Old People

Journal/Book: Reprinted from THE CANADIAN MEDICAL ASSOCIATION JOURNAL 94 932-939 April 30 1966. 1966;

Abstract: AGUZZI G. M.D. WOOLF C. R. M.D. M.R.C.P. (Lond.) F.R.C.P. [ C ] and PATERSON J. F. M.D. M.R.C.P.(Lond.) F.R.C.P. [ C ] From the Geriatric Study Centre 350 Christie St.. Toronto. Ontario the Cardio-Respiratory Laboratory Toronto General Hospital and the Department of Medicine University of Toronto. This investigation was supported by grants Prom the Ontario Geriatric Research Society (with funds from the Bickell Foundation) and the Canadian Tuberculosis Association. Reprint requests to: Dr. C. R. Woolf Cardio-Respiratory Laboratory Toronto General Hospital 101 College Street Toronto 2. Ont. SUMMARY A study was undertaken of 100 men and 100 women between the ages of 70 and 89 years to determine the prevalence and type of chronic obstructive bronchopulmonary disease in very old people. The investigation consisted of a history and physical examination chest radiograph electrocardiogram and pulmonary function tests. Seventeen men and 27 women were considered clinically normal. In the normal old people the results of the total vital capacity and maximum voluntary ventilation could be closely related to the predicted normal values of Baldwin Cournand and Richards.5 All the normal subjects had a forced expiratory volume (one second) greater than 70 % of the forced vital capacity. The maximum mid-expiratory flow rate in all but two of the normal subjects was greater than 1 litre per second. The diffusing capacity of 12 of the normal subjects was 17.4 ± 6.3 ml./min./mm. Hg (mean ± S.D.). The mean fractional carbon monoxide uptake of the same subjects was 38.9 ± 5.4 % (mean ± S.D.). If the diagnosis of chronic obstructive bronchopulmonary disease depended an rhonchi then this disorder was present in 45 % of the old men and 24 % of the old women; if this diagnosis depended on an FEV1 less than 60 % of the total FVC then the prevalence of chronic obstructive lung disease was 23 % in men and 6 % in women; if it depended on an MMFR less than 1 l./sec. then 37 % of old men and 49 % of old women had chronic obstructive lung disease. Arguments are advanced to suggest that the FEV1 results constitute the best index of the prevalence of chronic obstructive bronchopulmonary disease. Chronic bronchitis was present in 32 % of the old men and 12 % of the old women but not all of these old people with chronic cough had a significantly low FEV1. To make a diagnosis of emphysema an FEV1 less than 60 % of the FVC together with carbon monoxide diffusing capacity less than 11 ml./min./mm. Hg and a fractional CO uptake less than 33.5 % was required. Only five individuals all men satisfied these criteria. The present study confirmed that radiographs of the chest are of little value in the diagnosis of either hyperinflation of the lungs or emphysema. In old people there was a relationship between smoking chronic cough and obstruction to air flow. ___MH

Zurück | Weiter