Lung Disease and the Aging Adult

For my sins, I am currently acting as the interim division director for general internal medicine and geriatrics at my hospital. A quick tour around the general medical units revealed the following information. Most of the inpatients are older and shortness of breath is the most common symptom they arrive with. The likeliest reasons for the shortness of breath are congestive heart failure (CHF), an exacerbation of chronic lung disease, and pneumonia. Many of those with CHF or pneumonia also have underlying chronic lung disease as a predisposing factor. There are many reasons for the high prevalence of chronic lung disease in older adults, but I believe that the major reason is the one most obvious: they have been smokers for many, many years. I do not believe that it is ever too late to stop smoking, and when we see older patients in our offices or on the wards, it behooves us to determine in each case if there is a smoking history and prudently offer to provide the tools to help them stop if they are presently smokers.

This issue focuses on lung diseases in older adults and covers a variety of topics. Dr. Jean Bourbeau tackles a large topic in his article “Diagnosis and Management of Chronic Obstructive Pulmonary Disease in Older Adults.” Drs. Ashraf Alzaabi and Theodore Marras review the “Management of Community-Acquired Pneumonia in Older Adults,” while Drs. Samir Gupta and Robert Hyland have contributed the article “Hemoptysis in Older Adults: Etiology, Diagnosis, and Management.” Next, Dr. Nasreen Khalil reviews “Bronchiectasis in Older Adults.” My experience has been that as CT scans of the chest are performed more routinely, we are making the diagnosis more frequently.
As well, we have our usual collection of interesting topics in other areas. Dr. Diego Delgado has written about the “Diagnosis and Management of Diastolic Heart Failure,” while Rory Fisher and Eoin Connolly review the issue of “Artificial Nutrition and Hydration in the Management of End-Stage Dementias.” In the last few years, real information is being presented on this topic, rather than the opinions and ivory tower philosophical discussions that were published in years past. Dr. Fisher is one of those who have contributed to that scientific base on the topic. Drs. Dror Marchaim, Victor Dishy, and Ahuva Golik present a timely reminder, “Concepts in Geriatric Clinical Pharmacology” for our Drugs & Aging column. Finally, Drs. Loren Mell and Arno Mundt review the topic of “Radiation Therapy in Older Adults”.

I hope you all survived the recent holiday season with your waistlines intact.

Enjoy this issue,

Barry Goldlist