COPD in the elderly : diagnostic criteria, symptoms and smoking. Quantitative and qualitative studies of persons over sixty years of age in The Tromsø studies.

Abstract

SUMMARY Smokers benefit from the enjoyment and fellowship smoking brings in the short term, yet may cause diseases and disability later in life. This thesis is about COPD, the spirometry criteria for diagnosis, the predictive value of respiratory symptoms, and smoking and its cessation.

Paper 1 and 2 are quantitative, epidemiological studies, which were based on a cross sectional population study in the city of Tromsø, Norway, in 2001. We chose to do our research on people aged 60 years and above since COPD is usually detected in this age group, and we had access to a representative sample from the Tromsø 5 study. In addition to spirometry the papers are based on data from questionnaires.

The research question in paper 1was: Can we use FEV1 /FVC<70% as a criterion of COPD in all ages? Main results paper 1: The frequency of FEV1 /FVC ratio <70% was approximately 7% in never smokers aged 60–69 years compared to 16–18% in those of 70 years of age or more (p<0.001). FEV1 /FVC ratio <70% among never smokers aged 60–69 years was as frequent as FEV1 /FVC ratio <65% among never smokers older than 70 years. Conclusion: Adjustments of the GOLD criteria for diagnosing COPD are needed, and FEV1 / FVC ratios down to 65% should be regarded as normal when aged 70 years and older.

The research question in paper 2 was: What role may symptoms play in the diagnosis of airflow limitation? Main results paper 2: The prevalence of any airflow limitation, (defined as FEV1 /FVC ratio <70% in subjects <70 years old and <65% in subjects ≥70 years old) was 15.5% and 20.8%, in women and men, respectively. Whereas the corresponding prevalences of severe airflow limitation (FEV1 <50% predicted) were 3.4% and 4.9%. The increased risk of having any airflow limitation corresponded to an OR 2.4 among ex-smokers and OR 5.8 among current smokers compared to never smokers. The prevalence of airflow limitation was more than doubled amongst never-and ex-smokers when two or more of the symptoms wheeze, dyspnoea or cough with phlegm were reported, compared to only one. Ex-smokers reporting two symptoms had a similar risk of airflow limitation as current smokers not reporting any symptoms. Conclusion: Respiratory symptoms are valuable predictors of airflow limitation, and should be emphasized when selecting patients for spirometry.

Paper 3 is a qualitative document, based on interviews with 18 participants of 58 years of age and older. Research question in paper 3: “What makes people start smoking, and a smoker to quit and maintain quitted?” Main results: The influence of “all the others” is essential when starting to smoke. In the process of stopping smoking, relapses and continued smoking, the spouses have a vital influence. Smoking cessation often seemed to be unplanned. Finally with an increasingly negative social attitude towards smoking, increased the informant`s awareness of the risks of smoking. Conclusion: “All the others” is a clue in the smoking story. For smoking cessation, it is essential to be aware of the influence of friends and family members, especially a spouse. People may stop smoking unplanned, even when motivation is not obvious. Information from the community and doctors on the negative aspects of smoking should continue. Eliciting life-long smoking narratives may open up for a fruitful dialogue, as well as prompting reflection about smoking and adding to the motivation to stop.