age-associated changes in pulmonary function
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Introduction
Pulmonary function declines with age
Pharmacology
- diminished responsiveness of asthmatics to glucocorticoids[6]
Physiology
- decreased elasticity of lung parenchyma
- changes
- consequences
- increased work of breathing
- enlarged alveolar ducts
- enlarged alveoli[5], but decreased alveolar surface area
- maximum inspiratory & expiratory pressures decrease
- decrease in exercise tolerance
- decreased activity of cilia
- decreased vital capacity
- FEV1 decreases 30 mL/year
- FVC decreases similarly
- no change in total lung capacity[5]
- increased residual volume (dead space)
- functional residual capacity increases slightly with age[11]
- increased end-expiratory lung volume in elderly with exercise[5]
- decreased DLCO 0.5%/year
- decreased maximum oxygen uptake (VO2 max)
- decreased cough reflex, cough less effective in clearing secretions[5]
- increased airway reactivity
- diminished pO2
- secondary to V/Q mismatch
- increased A-a gradient[5]
- worse in supine than sitting position
- estimate by eq: 100 - age/3 (90 yrs = 70 mm Hg)
- secondary to V/Q mismatch
- decreased response to hypoxia & hypercarbia
- increased pulmonary artery pressure
- muscles of respiration: decreased strength & endurance
- weaking of intercostal muscles results in greater dependence on diaphragm muscle
- along with loss of muscle oxidative capacity & reduced cardiac output, manifests as decreased exercise tolerance[5]
- trachea & central airways increase in diameter
- decreased lung mass
- expansion of thorax
- costal cartilage calficies, chest wall stiffens, chest compliance decreases[5]
- persons 60-80 years emit a larger number & volume of lung aerosol particles at rest & during exercise than persons 20-40 years of age[10]
- may have implications for transmissibility of lower respiratory tract infections among elderly[10]
* GRS11[5] notes a loss of elastin fibers & an increase in cross-linking (unspecified), then goes on to mention a remodeling of the lung elastin-collagen network contributing to chest wall stiffness & decreases in peak expiratory flow in the elderly
* GRS11[5] seems to infer that loss of elastin fiber cross-links is not associated with age-associated decline in exercise tolerance
More general terms
Additional terms
References
- ↑ Essentials of Clinical Geriatrics, 4th ed, Kane RL et al (eds) McGraw Hill, NY, 1999
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ The Merck Manual of Geriatrics, 3rdh ed, Merck & Co, Rahway NJ, 2000
- ↑ Taffet GE, Physiology of Aging, In: Geriatric Medicine: An Evidence-Based Approach, 4th ed, Cassel CK et al (eds), Springer-Verlag, New York, 2003
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 6.0 6.1 Dunn RM et al Impact of Age and Gender on Response to Asthma Therapy. Am J Respir Crit Care Med. First published online 11 Jun 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26068329 <Internet> http://www.atsjournals.org/doi/abs/10.1164/rccm.201503-0426OC
- ↑ Cho SJ, Stout-Delgado HW. Aging and lung disease. Annu Rev Physiol. 2020;82:433-459 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31730381 PMCID: PMC7998901 Free PMC article
- ↑ Roman MA, Rossiter HB, Casaburi R. Exercise, ageing and the lung. Eur Respir J. 2016;48(5):1471-1486 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27799391 Free article https://erj.ersjournals.com/content/48/5/1471
- ↑ Skloot GS. The effects of aging on lung structure and function. Clin Geriatr Med. 2017;33(4):447-457 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28991643 https://www.geriatric.theclinics.com/article/S0749-0690(17)30050-2/fulltext
- ↑ 10.0 10.1 10.2 Schumm B et al. Lung aerosol particle emission increases with age at rest and during exercise. Proc Natl Acad Sci U S A 2023 May 22; 120:e2301145120 https://www.pnas.org/doi/10.1073/pnas.2301145120
- ↑ 11.0 11.1 Hopkins E, Sharma S Physiology, Functional Residual Capacity StatPearls [Internet]. Dec 26, 2022 NLM, NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK500007