Pulmonary Changes in the Elderly

Chapter

Abstract

There are multiple changes that occur to the respiratory system with aging. In the absence of significant disease, the majority of such changes do not result in any significant impact on lung health. However, such changes do affect physiologic testing and susceptibility to environmental insults which are essential to understand in the context of the patient being considered for thoracic surgery. Normal physiologic changes to the chest wall and supporting structures, airway and lung compliance, alveolar surface area, and pulmonary vasculature all result in a reduction in lung function and may also be associated with reduced exercise capacity. Gas transfer in elderly patients is less efficient than those who are younger, but this seldom is clinically significant. Elderly patients are also more susceptible to infection and a higher mortality associated with such infections due to alterations in host defense mechanisms and the frequency of comorbid conditions.

Keywords

Aging Elderly Lung function Compliance Resistance Small airways Senile emphysema Kyphosis Respiratory muscles Spirometry Vital capacity Total lung capacity Residual volume Closing volume Diffusing capacity Maximum oxygen consumption Host defense Pneumonia 

References

  1. 1.
    Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977;1:1645–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Estenne M, Yernault JC, De Troyer A. Rib cage and diaphragm-abdomen compliance in humans: effects of age and posture. J Appl Physiol. 1985;59:1842–8.PubMedGoogle Scholar
  3. 3.
    Edge JR, Millard FJ, Reid L, Simon G. The radiographic appearances of the chest in persons of advanced age. Br J Radiol. 1964;37:769–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999;13:197–205.PubMedCrossRefGoogle Scholar
  5. 5.
    Polkey MI, Harris ML, Hughes PD, et al. The contractile properties of the elderly human diaphragm. Am J Respir Crit Care Med. 1997;155:1560–4.PubMedGoogle Scholar
  6. 6.
    Bassey EJ, Harries UJ. Normal values for handgrip strength in 920 men and women aged over 65 years, and longitudinal changes over 4 years in 620 survivors. Clin Sci (Lond). 1993;84:331–7.Google Scholar
  7. 7.
    Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE. Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med. 1994;149:430–8.PubMedGoogle Scholar
  8. 8.
    Hautmann H, Hefele S, Schotten K, Huber RM. Maximal inspiratory mouth pressures (PIMAX) in healthy subjects–what is the lower limit of normal? Respir Med. 2000;94:689–93.PubMedCrossRefGoogle Scholar
  9. 9.
    Arora NS, Rochester DF. Effect of body weight and muscularity on human diaphragm muscle mass, thickness, and area. J Appl Physiol. 1982;52:64–70.PubMedGoogle Scholar
  10. 10.
    Turner JM, Mead J, Wohl ME. Elasticity of human lungs in relation to age. J Appl Physiol. 1968;25:664–71.PubMedGoogle Scholar
  11. 11.
    Gillooly M, Lamb D. Airspace size in lungs of lifelong non-smokers: effect of age and sex. Thorax. 1993;48:39–43.PubMedCrossRefGoogle Scholar
  12. 12.
    Pierce JA. Age related changes in the fibrous proteins of the lungs. Arch Environ Health. 1963;6:50–4.PubMedGoogle Scholar
  13. 13.
    Kurozumi M, Matsushita T, Hosokawa M, Takeda T. Age-related changes in lung structure and function in the senescence-accelerated mouse (SAM): SAM-P/1 as a new murine model of senile hyperinflation of lung. Am J Respir Crit Care Med. 1994;149:776–82.PubMedGoogle Scholar
  14. 14.
    Niewoehner DE, Kleinerman J. Morphologic basis of pulmonary resistance in the human lung and effects of aging. J Appl Physiol. 1974;36:412–8.PubMedGoogle Scholar
  15. 15.
    Wahba WM. Influence of aging on lung function–clinical significance of changes from age twenty. Anesth Analg. 1983;62:764–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Sorbini CA, Grassi V, Solinas E, Muiesan G. Arterial oxygen tension in relation to age in healthy subjects. Respiration. 1968;25:3–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Blom H, Mulder M, Verweij W. Arterial oxygen tension and saturation in hospital patients: effect of age and activity. Br Med J. 1988;297:720–1.CrossRefGoogle Scholar
  18. 18.
    Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM. Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation. 2009;119:2663–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Davidson Jr WR, Fee EC. Influence of aging on pulmonary hemodynamics in a population free of coronary artery disease. Am J Cardiol. 1990;65:1454–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948–68.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26:511–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Kerstjens HA, Rijcken B, Schouten JP, Postma DS. Decline of FEV1 by age and smoking status: facts, figures, and fallacies. Thorax. 1997;52:820–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Kalhan R, Arynchyn A, Colangelo LA, Dransfield MT, Gerald LB, Smith LJ. Lung function in young adults predicts airflow obstruction 20 years later. Am J Med. 2010;123:468.e1–7.CrossRefGoogle Scholar
  25. 25.
    Burrows B, Lebowitz MD, Camilli AE, Knudson RJ. Longitudinal changes in forced expiratory volume in one second in adults. Methodologic considerations and findings in healthy nonsmokers. Am Rev Respir Dis. 1986;133:974–80.PubMedGoogle Scholar
  26. 26.
    Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–55.PubMedCrossRefGoogle Scholar
  27. 27.
    Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis. 1993;147:125–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Schermer TRJ, Smeele IJM, Thoonen BPA, et al. Current clinical guideline definitions of airflow obstruction and COPD overdiagnosis in primary care. Eur Respir J. 2008;32:945–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Vaz Fragoso CA, Concato J, McAvay G, et al. The ratio of FEV1 to FVC as a basis for establishing chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;181:446–51.PubMedCrossRefGoogle Scholar
  30. 30.
    Carlos AVF, John C, Gail M, et al. Defining chronic obstructive pulmonary disease in older persons. Respir Med. 2009;103:1468–76.CrossRefGoogle Scholar
  31. 31.
    Janssens JP. Aging of the respiratory system: impact on pulmonary function tests and adaptation to exertion. Clin Chest Med. 2005;26:469–84, vi–vii.Google Scholar
  32. 32.
    Crapo RO. The aging lung. In: Mahler DA, editor. Pulmonary disease in the elderly patient. New York: Marcel Dekker; 1993. p. 1–21.Google Scholar
  33. 33.
    Cardus J, Burgos F, Diaz O, et al. Increase in pulmonary ventilation-perfusion inequality with age in healthy individuals. Am J Respir Crit Care Med. 1997;156:648–53.PubMedGoogle Scholar
  34. 34.
    McClaran SR, Babcock MA, Pegelow DF, Reddan WG, Dempsey JA. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults. J Appl Physiol. 1995;78:1957–68.PubMedGoogle Scholar
  35. 35.
    Loeb M, McGeer A, McArthur M, Walter S, Simor AE. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med. 1999;159:2058–64.PubMedCrossRefGoogle Scholar
  36. 36.
    Kirkwood TB, Ritter MA. The interface between ageing and health in man. Age Ageing. 1997;26 Suppl 4:9–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations