Interventional pulmonology techniques in elderly patients with comorbidities
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.
References (56)
Comorbidities of lung disease in the elderly
Clin Geriatr Med
(2017)- et al.
Lung cancer in the older patient
Clin Geriatr Med
(2017) - et al.
Flexible bronchoscopy in the elderly
Clin Chest Med
(2001) - et al.
Premedication for bronchoscopy in older patients: a double-blind comparison of two regimens
Respir Med
(2005) - et al.
EBUS-TBNA in elderly patients with lung cancer: Safety and performance outcomes
J Thorac Oncol
(2014) - et al.
Fibreoptic bronchoscopy in the elderly: 4 years' experience
Br J Dis Chest
(1988) - et al.
Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy
Chest
(2011) - et al.
Randomized trial of endobronchial ultrasound-guided transbronchial needle aspiration with and without rapid on-site evaluation for lung cancer genotyping
Chest
(2015) - et al.
Tuberculosis in young adults and the elderly. A prospective comparison study
Chest
(1994) - et al.
Bronchoscopic techniques in the management of patients with tuberculosis
Int J Infect Dis
(2017)