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Matera MG, Hanania NA, Maniscalco M, Cazzola M. Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities. Drugs Aging 2023:10.1007/s40266-023-01038-0. [PMID: 37316689 DOI: 10.1007/s40266-023-01038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
Older adults have a higher prevalence of chronic obstructive pulmonary disease (COPD), which will likely increase substantially in the coming decades owing to aging populations and increased long-term exposure to risk factors for this disease. COPD in older adults is characterized by low-grade chronic systemic inflammation, known as inflamm-aging. It contributes substantially to age-associated pulmonary changes that are clinically expressed by reduced lung function, poor health status, and limitations in activities of daily living. In addition, inflamm-aging has been associated with the onset of many comorbidities commonly encountered in COPD. Furthermore, physiologic changes that are often seen with aging can influence the optimal treatment of older patients with COPD. Therefore, variables such as pharmacokinetics, pharmacodynamics, polypharmacy, comorbidities, adverse drug responses, drug interactions, method of administration, and social and economic issues that impact nutrition and adherence to therapy must be carefully evaluated when prescribing medication to these patients because each of them alone or together may affect the outcome of treatment. Current COPD medications focus mainly on alleviating COPD-related symptoms, so alternative treatment approaches that target the disease progression are being investigated. Considering the importance of inflamm-aging, new anti-inflammatory molecules are being evaluated, focusing on inhibiting the recruitment and activation of inflammatory cells, blocking mediators of inflammation thought to be important in the recruitment or activation of these inflammatory cells or released by these cells. Potential therapies that may slow the aging processes by acting on cellular senescence, blocking the processes that cause it (senostatics), eliminating senescent cells (senolytics), or targeting the ongoing oxidative stress seen with aging need to be evaluated.
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Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133, Rome, Italy.
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Matsuo A, Takamori A, Kawaura F, Iwanaga Y, Ono H, Kobayashi-Watanabe N, Kuwahara M, Takagi K, Nagasawa Z, Fujimoto K, Hayashi S. Risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients: a retrospective study in Japan. J Clin Biochem Nutr 2020; 67:302-306. [PMID: 33293772 PMCID: PMC7705084 DOI: 10.3164/jcbn.20-85] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 12/18/2022] Open
Abstract
The present study aimed to reveal; i) risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients, and ii) whether swallowing ability was related to re-hospitalization. The present retrospective study included 92 patients older than 75 years hospitalized with community acquired pneumonia in Takagi Hospital between April 2017 and March 2018. The patients were classified into 3 groups; discharged within 17 days (group I): hospitalized more than 18 days (group II): died during the hospitalization (group III). Swallowing ability was evaluated if available. Univariate analysis indicated males and body mass index (BMI) in group I (n = 24) were higher than group II (n = 46). Group III (n = 22) had low serum albumin, low BMI, and severe disease progression compared with group I. Multivariate analysis demonstrated that group II BMI was lower than group I [odds ratio (OR) = 1.18, p = 0.042]. Group III had lower serum albumin level compared with group I (OR = 81.01, p = 0.025). Diabetes mellitus (p = 0.009), but not swallowing disability, was risk for readmission. Malnutrition represented by low albumin enhanced mortality rate in the pneumonia patients, and low BMI and diabetes mellitus might increase the pneumonia risk.
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Affiliation(s)
- Ayako Matsuo
- International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan.,Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Futoshi Kawaura
- Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Yasunari Iwanaga
- Otorhinolarygology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Hitomi Ono
- Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Naomi Kobayashi-Watanabe
- Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Motohisa Kuwahara
- Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
| | - Kuniaki Takagi
- International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan
| | - Zennzou Nagasawa
- International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan
| | - Kazuma Fujimoto
- International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan
| | - Shinnichiro Hayashi
- International University of Health and Welfare Graduate School of Medicine, 137-1 Enokizu, Ookawa-city, Fukuoka 831-8501, Japan.,Divisions of Respirology, Kouhou-kai Takagi Hospital, 141-11 Sakami, Ookawa-city, Fukuoka 831-0016, Japan
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