Aspects of Spirometry and Inhaler Therapy in Frail Elderly Patients: Barriers and Alternatives

Allen S. Aspects of spirometry and inhaler therapy in frail elderly patients: barriers and alternatives.  Annals of Respiratory Medicine, February 2010; 1(1):53-59

Review Article

C Stephen Allen
Affiliations: The Royal Bournemouth Hospital and Centre of Postgraduate Medical Research and Education, Bournemouth University


ABSTRACT

As patients age beyond 65 years, the proportion who are unable to perform spirometry or learn to use an inhaler increases. This impedes the accurate assessment of respiratory diseases and reduces the opportunity for reliable self‐administered treatment. The most important barrier to spirometry and inhaler use in old age is cognitive impairment, and studies have shown that patients with a Mini Mental State Examination (MMSE) score of <24/30, and/or Abbreviated Mental Test Score (AMTS) <7/10, and/or inability to copy intersecting pentagons are not likely to perform spirometry reliably or learn to use any inhaler device consistently. Age itself is not the determining factor, and most elderly people with normal cognition can do spirometry and use an inhaler correctly. Patients with mild to moderate cognitive problems are the most vulnerable in this respect as their impairment can be easily missed, in which case alternative arrangements might not be made. The routine use of cognitive screening tests, such as the MMSE, helps to identify such patients. Patients unable to use an inhaler almost always need assisted inhaled therapy with an attendant using a spacer device or nebulizer. For some patients with mild cognitive impairment, partial spirometry, such as forced expiratory volume in 1 s (FEV1) alone or FEV1/FEV3 ratio, can be achieved and can be used cautiously as part of an overall clinical respiratory assessment. Slow (relaxed) vital capacity is not a useful alternative to forced vital capacity (FVC) for elderly patients with cognitive impairment.

Keywords: elderly, spirometry technique, inhaler technique, cognitive function
Correspondence: Stephen C Allen, The Royal Bournemouth Hospital and Centre of Postgraduate Medical Research and Education, Bournemouth University, Bournemouth, Dorset BH7 7DW, UK