The interaction of ageing and lung disease

Abstract

This article explores the structural and physiological changes that occur in the ageing lung, and the impact that lung disease and other co-morbidities may have on it. The major changes associated with ageing are reduced lung elasticity, respiratory muscle strength and chest wall compliance, all of which may be influenced by impaired lung growth in early childhood and adolescence. The resultant reduction in diffusing capacity may not be relevant in a fit older adult, but co-morbidities may interact to cause breathlessness and impairments in quality of life. Lung function declines with age, but forced vital capacity (FVC) begins to decline later than forced expiratory volume in 1 s (FEV 1 ) and at a slower rate. This results in a natural fall in the FEV 1 /forced vital capacity (FVC) ratio which may result in overdiagnosis of chronic obstructive pulmonary disease, and hence the need to ensure the FEV 1 is less than 80% before confirming the diagnosis. As older adults probably have a diminished response to hypoxia and hypercapnia, they become more vulnerable to ventilatory failure during high-demand states such as heart failure and pneumonia and therefore to possible poorer outcomes. Poor nutritional status is likely to be an important factor, as is cognitive impairment. It is important to assess older patients using a range of clinical and physiological parameters rather than on the basis of age per se which is a poor predictor of outcome.

Genetic and Environmental Effects on Telomere Length and Lung Function: A Twin Study

“…However, this association with LTL was not observed with the other lung function variables. It is known that, with aging, FEV 1 begins to decline earlier and at a much faster rate than, for example, FVC, which might explain our findings (37). In a large meta-analysis the associations between LTL and lung function variables have also been reported to be stronger in asthmatics and chronic obstructive lung disease patients than healthy controls (7).…”

How Common Is Airflow Limitation in Patients With Emphysema on CT Scan of the Chest?

“…13,23,41,42 However, we suspect that people in this group either have subclinical COPD that may progress over time 12,21,43 or have a physiologic amount of emphysema that accompanies the normal loss of lung function with age. 44,45 Th ere are several limitations to our study. Th is was a retrospective study that examined a cohort of patients with chest CT scans, which were performed for a variety of clinical reasons.…”

Associations between muscle strength, spirometric pulmonary function and mobility in healthy older adults

“…Major intrinsic reasons for declining pulmonary function with age are suggested to be loss of lung elasticity, aggravated by increasing stiffness of the chest wall and reduced strength of respiratory muscles controlling exhalation (Dyer 2012). Muscle strength and mass decrease gradually during aging (Porter et al 1995;Vandervoort.…”