http://jama.jamanetwork.com/ en-us Mon, 10 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:45:14 GMT Silverchair editor@jama.jamanetwork.com webmaster@jama.jamanetwork.com http://jama.jamanetwork.com/article.aspx?articleID=1361999 Wed, 26 Sep 2012 00:00:00 GMT Fried TR, Fragoso C, Rabow MW. <span class="paragraphSection">Chronic obstructive pulmonary disease (COPD), a common disease in elderly patients, is characterized by high symptom burden, health care utilization, mortality, and unmet needs of patients and caregivers. Respiratory failure and dyspnea may be exacerbated by heart failure, pulmonary embolism, and anxiety; by medication effects; and by other conditions, including deconditioning and malnutrition. Randomized controlled trials, which provide the strongest evidence for guideline recommendations, may underestimate the risk of adverse effects of interventions for older patients with COPD. The focus of guidelines on disease-modifying therapies may not address the full spectrum of patient and caregiver needs, particularly the high rates of bothersome symptoms, risk of functional and cognitive decline, and need for end-of-life care planning. Meeting the many needs of older patients with COPD and their families requires that clinicians supplement guideline-recommended care with treatment decision making that takes into account older persons' comorbid conditions, recognizes the trade-offs engendered by the increased risk of adverse events, focuses on symptom relief and function, and prepares patients and their loved ones for further declines in the patient's health and their end-of-life care. A case of COPD in an 81-year-old man hospitalized with severe dyspnea and respiratory failure highlights both the challenges in managing COPD in the elderly and the limitations in applying guidelines to geriatric patients.</span> 308 12 1254 1263 10.1001/jama.2012.12422 http://jama.jamanetwork.com/article.aspx?articleID=1361999 http://jama.jamanetwork.com/article.aspx?articleID=1362025 Wed, 26 Sep 2012 00:00:00 GMT Torpy JM, Goodman DM, Burke AE, et al. <span class="paragraphSection">Chronic obstructive pulmonary disease (COPD) is one of the most common lung disorders in adults and includes chronic bronchitis and emphysema. In COPD, the airway passages (known as bronchi and bronchioles) become obstructed because of inflammation and excess sputum (phlegm) production. With emphysema, the alveoli (tiny air sacs of the lung where oxygen is absorbed and carbon dioxide is released) are partially destroyed. These problems result in difficulty breathing and decreased amounts of oxygen delivered to the body's tissues. COPD affects between 12 million and 24 million persons and is a leading cause of death in the United States. COPD affects both men and women, and the most common cause is smoking (accounting for 80%-90% of cases). The September 26, 2012, issue of JAMA includes an article about COPD. This Patient Page is based on one previously published in the June 16, 2010, issue of JAMA.</span> 308 12 1281 1281 10.1001/jama.2012.12362 http://jama.jamanetwork.com/article.aspx?articleID=1362025