The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Jean Bourbeau MD, MSc, FRCPC, Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre; Respiratory Epidemiology and Clinical Research Unit, Department of Epidemiology and Biostatistics, McGill University, Montreal, QC.

With the population progressively aging, the geriatric aspects of COPD deserve special consideration. Older adults with respiratory symptoms and a current or previous history of smoking should be considered for a diagnosis of COPD. Objective demonstration of airflow obstruction is mandatory for the diagnosis of COPD. The majority of older people can adequately perform spirometry for an objective demonstration of airflow obstruction. Nonpharmacological treatment includes smoking cessation, vaccination, self-management education and communication with a case manager, and pulmonary rehabilitation. Bronchodilators are the most important agents in the pharmacotherapy of COPD. Inhaled corticosteroids are indicated for patients with recurrent exacerbations who are already on optimal bronchodilator therapy.

Key words: chronic obstructive pulmonary disease, older adults, diagnosis, spirometry, management.

Ian K. Tsang, MB, FRCPC, Clinical Professor, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.

Gout is more prevalent in older adults than middle-age adults, and it affects women almost as commonly as men. An important clinical consideration regarding gout is that while hyperuricemia is commonly associated with gouty arthritis, a diagnosis of asymptomatic hyperuricemia does not generally require treatment. In addition, the clinical presentation and course of gout in older patients differ from the typical cases of middle-aged patients. Moreover, older gout patients present a challenge for physicians who manage them because of the high incidence of comorbid conditions and the likely occurrence of reduced renal function among this age group. This article reviews the diagnosis and management of asymptomatic hyperuricemia and gout in the older adult.
Key words: gout, hyperuricemia, NSAID, allopurinol, arthritis.