Asthma and COPD in older people

Obstructive Airway Diseases (OAD) such as asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions among older people where they are associated with a significant and increasing disease burden. The management of these conditions in older people is complex. The complexities relate to the heterogeneity that exists in asthma and COPD in the older population, the increased prevalence of co-morbidity that occurs with both advancing age and OAD, and the consequences of ageing including age related structural changes that occur in the lung. The current approach to the management of older people with asthma or COPD is to establish a diagnosis and implement disease specific clinical practice guidelines. This approach however is limited as the clinical trials that inform guidelines have largely excluded older people and those with overlap OAD or co-morbidity. A further restriction of this approach is that many of the guidelines for asthma and COPD give limited consideration to the consequences of ageing or the existence of multiple complex co-morbidities and do not necessarily address what is important to the patient. Opportunities exist to improve the management and outcomes for older people with OAD and the research undertaken in this thesis sought to do this. The research reported in this thesis aimed to improve our current understanding of Asthma, COPD and the overlap of asthma and COPD in an older population, and to develop an improved approach to the management of these patients. A mixed methods approach was used involving a cross sectional observation study, qualitative interviews and a controlled clinical trial. This research has extended our knowledge of the clinical impacts of these conditions from a biological, clinical, functional and person centred perspective and describes a management approach that significantly improves the health status of older people with OAD.