COPD in the older adult: a comprehensive geriatric perspective, from GOLD 2026 to the bedside

Luis Torre-Bouscoulet, Department of Respiratory Physiology, Instituto de Desarrollo e Innovación en Fisiología Respiratoria; Department of Pulmonology, Médica Sur Clinic and Foundation. Mexico City, Mexico

In older adults, chronic obstructive pulmonary disease (COPD) is no longer a single disease but a multidimensional problem: beyond respiratory impairment per se, it coexists with frailty, multimorbidity, and polypharmacy. Yet most clinical guidelines are built on studies of younger patients with little comorbidity. This review highlights the particularities the clinician should recognize. The diagnosis of obstruction should rest on the lower limit of normal of the forced expiratory volume in 1 s/forced vital capacity ratio, not on the fixed ratio of 0.70, to avoid overdiagnosis. COPD also settles on a lung that has undergone its own senescence, and both dyspnea and hypoxemia are often multifactorial: they should not be attributed to COPD alone. Pharmacological treatment requires weighing risks and benefits, with particular attention to anticholinergic burden. Finally, in Latin America, biomass smoke and tuberculosis sequelae are important causes of COPD, and care is further shaped by high-altitude living and unequal access to medications and supplemental oxygen. On this basis, this review offers a practical framework to individualize decisions in older adults with COPD. 

Keywords: Chronic obstructive pulmonary disease. Aged. Frailty. Multimorbidity. Polypharmacy. Spirometry.