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Physiologic Changes in the Aging Lung

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Aging and Lung Disease

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Aerobic cellular metabolism, a fundamental requisite for homeostasis, is dependent on oxygen delivery (O2D) and acid–base status. These, in turn, require a ventilatory response that couples gas exchange at the lung with metabolism at the cellular level. Senescence-based mechanisms adversely affect the ventilatory response, however, through reductions in respiratory physiology, termed normal aging, and through increases in the prevalence of cardiopulmonary disease, termed usual aging. Both forms of aging can lead to impairments in central respiratory drive, respiratory muscle strength, respiratory mechanics, and lung perfusion, yielding various forms of alveolar hypoventilation and the mismatch of ventilation with (lung) perfusion. Clinically, these impairments increase the risk of exercise intolerance and respiratory failure, including disturbances in O2D and acid–base status. Those at highest risk are older persons with cardiopulmonary disease, particularly if they are also obese, report the use of respiratory suppressants, or are in the midst of an episode of acute lung injury such as pneumonia. This chapter reviews the adverse effects of normal aging on respiratory physiology, at rest and with exercise. It also includes an illustrative case presentation and a discussion regarding the clinical implications of age-related reductions in respiratory physiology, relative to cardiopulmonary disease, obesity, respiratory suppressants, and acute lung injury.

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Abbreviations

(A − a)DO2 :

Alveolar–arterial PO2 difference

CaO2 :

Arterial oxygen content

CvO2 :

Venous oxygen content

f b :

Breathing frequency (respiratory rate)

FEV1 :

Forced expiratory volume in 1 s

[H+]:

Hydrogen ion concentration

Hb:

Hemoglobin

HCO3 :

Bicarbonate

MBC:

Maximal breathing capacity

Na:

Sodium

O2D:

Oxygen delivery

PaCO2 :

Arterial carbon dioxide tension

PaO2 :

Arterial oxygen tension

PAO2 :

Alveolar partial pressure of oxygen

PIO2 :

Inspired oxygen tension

RQ:

Respiratory quotient (\( {\text{V ˙CO}}_{2}/{\text{V ˙O}}_{2}\))

SaO2 :

Arterial oxygen saturation of hemoglobin

\( {\text{V ˙CO}}_{2}\) :

Production of CO2

\( {\text{V ˙O}}_{2}\) :

Consumption of oxygen

\( {\dot{V}}_{\text{A}}\) :

Alveolar minute ventilation

\( {\dot{V}}_{\text{D}}\) :

(Physiologic) dead space ventilation

\( {\dot{V}}_{\text{E}}\) :

Total minute ventilation, as measured during expiration

\( {\dot{V}}_{\text{E}\mathrm{max}}\) :

Ventilation at maximum exercise

V t :

Tidal volume

V d :

Dead-space volume

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Authors and Affiliations

  1. Department of Medicine, Yale University School of Medicine and VA-CT Clinical Epidemiology Research, 950 Campbell Ave, West Haven, CT, 06516, USA

    Carlos A. Vaz Fragoso

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  1. Carlos A. Vaz Fragoso
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Correspondence to Carlos A. Vaz Fragoso .

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  1. School of Medicine, Pulmonary and Critical Care Medicine, Yale University, Cedar Street 330, New Haven, 06520-8057, Connecticut, USA

    Margaret Pisani

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Fragoso, C.A.V. (2012). Physiologic Changes in the Aging Lung. In: Pisani, M. (eds) Aging and Lung Disease. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-727-3_1

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  • DOI: https://doi.org/10.1007/978-1-60761-727-3_1

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