Interventional pulmonology techniques in elderly patients with comorbidities

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Highlights

  • Bronchoscopy is effective and safe in the management of chest diseases in the elderly.

  • A similar complication rate of bronchoscopy between younger and older patients exists.

  • A limited number of adverse events related to sedation are described in the elderly.

Abstract

Respiratory diseases are common cause of disability in the elderly and are often concomitant with other non-respiratory medical conditions. Interventional pulmonology includes advanced diagnostic and therapeutic techniques, successfully employed for benign and malignant pulmonary diseases with a good safety profile.

A few studies are available on the efficacy and the safety of these procedures (both bronchoscopic and pleural techniques) in the elderly. Paucity of data in these patients may support reluctant clinicians.

We carried out a non-systematic review aimed at describing the scientific literature on interventional pulmonology techniques in elderly patients with comorbidities.

We summarized indications, performance characteristics, and safety profile of bronchoscopic techniques in the elderly, comparing outcomes between older and younger patients. We explored the role of age on anesthesia and sedation protocols during endoscopic procedures and assessed the influence of comorbidities on bronchoscopic outcomes.

This review underlines that older age is not a barrier for implementing interventional pulmonology for diagnostic and therapeutic purposes.

Introduction

Life expectancy has significantly increased in the last century, particularly in high income countries, owing to national socio-economic improvement, prevention and control of deadly infectious diseases (e.g., vaccines, antibiotics), and public health interventions (e.g., sanitation, water potability) [1,2]. Elderly is usually associated with an age ≥ 65 years. However, geographical, sociological, and cultural factors can influence its definition and threshold [1,2].

Ageing can play a crucial role in the pathogenesis of several acute and chronic lung diseases. Respiratory disorders can be more prevalent, severe, and frequently associated with disability and comorbidities in older adults [3,4].

In particular, comorbidities can be caused by respiratory diseases and/or can share the same risk factors (i.e., smoking exposure). Their occurrence is associated with atypical clinical presentations and, then, diagnostic delays are frequently recorded [5].

Interventional pulmonology (IP) is a medical specialty relying on advanced and safe diagnostic and therapeutic procedures for the management of benign and malignant pulmonary diseases [6].

The British Thoracic Society Guidelines recommend flexible diagnostic bronchoscopy when clinically needed, independently from the age of the patient [7]. However, rare scientific manuscripts on its usefulness in the elderly may contribute to reluctant prescribing behaviors [8]. A better characterization of its performance and safety profile would be necessary, based on both the high prevalence of some respiratory disorders in older patients and the expected increase of life expectancy [[8], [9], [10]].

Aim of the present review is to describe the most important studies on IP techniques in elderly patients with comorbidities.

Section snippets

Methods

We carried out a non-systematic, narrative literature review. Scientific documents were mainly retrieved from Pubmed from its inception to June 2018. Only epidemiological studies performed in adult human beings and written in English were selected. The following key-words were combined to address our research question: bronchoscopy; interventional pulmonology; frail elderly; lung cancer; pleural diseases; thoracentesis; thoracoscopy; older patients.

Indications

Studies did not describe similar definitions for the age group “elderly” (Table 1) [8,[11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]].

The main medical conditions when bronchoscopy was performed were lung cancer (i.e., diagnosis and staging), infectious diseases (i.e., diagnosis), inhalations of foreign bodies (i.e., removal), atelectasis and hemoptysis (i.e., diagnosis and therapy) (Table 1) [8,[12], [13], [14], [15], [16], [17],

Conclusions

IP procedures are effective and safe when used in the management of pulmonary and pleural diseases and can be safely employed in the elderly.

Poor variability of indications between younger and older patients was proved in relation to different epidemiologic burdens. No significant differences were found in sampling techniques, diagnostic yield, therapeutic efficacy, and complications' rate. Endoscopic procedures are well tolerated and a limited number of sedation-related adverse events related

Declaration of interests

None.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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