Aging of the respiratory system

Article information

Kosin Med J. 2016;31(1):11-18
Publication date (electronic) : 2016 February 04
doi : https://doi.org/10.7180/kmj.2016.31.1.11
Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju-si, Gyeongsangnam-do, Korea
Corresponding Author: Ho Cheol Kim, Research Building No.205, Gyeongsang National University School of Medicine, 79, Gangnam-ro, Jinju-si, Gyeongsangnam-do, 52727, Korea Tel: +82-55-750-8684 Fax: +82-55-750-8618 E-mail: hochkim@gnu.ac.kr
Received 2016 January 08; Revised 2016 January 08; Accepted 2016 January 11.

Abstract

Abstract

Changes in the respiratory system caused by aging generally include structural changes in the thoracic cage and lung parenchyma, abnormal findings on lung function tests, ventilation and gas exchange abnormalities, decreased exercise capacity, and reduced respiratory muscle strength. Decreased respiratory system compliance caused by reduced elastic recoil of the lung parenchymaand thoracic cage is related to decreased energy expenditure by the respiratory system. Lung function, as measured by 1-second forced expiratory volume and forced vital capacity (FVC), decreases with age, whereas total lung capacity remains unchanged. FVC decreases because of increased residual volume and diffusion capacity also decreases. Increased physiological dead space and ventilation/perfusion imbalance may reduce blood oxygen levels and increase the alveolar-arterial oxygen difference. More than 20% decrease in diaphragmstrength is thought to beassociated withaging-related muscle atrophy. Ventilation per minute remains unchanged, and blood carbon dioxide concentration does not increase with aging. However, responses to hypoxia and hypercapnia are decreased. Exercise capacity also decreases, and maximum oxygen consumption decreases by >1%/year. Consequence of these changes, many respiratory diseases occur with aging. Thus, it is important to recognize these aging-related respiratory system changes.

References

1. 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.
2. 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.
3. Tockman MS. Aging of the respiratory system 1994. 499–507.
4. Zeleznik J. Normative aging of the respiratory system. Clin Geriatr Med 2003;19:1–18.
5. Verbeken EK, Cauberghs M, Mertens I, Clement J, Lauweryns JM, Van de Woestijne KP. The senile lung; Comparison with normal and emphysematous lungs. 1. Structural aspects. Chest 1992;101:793–9.
6. Stocks J, Quanjer PH. Reference values for residual volume, functional residual capacity and total lung capacity: ATS Workshop on Lung Volume Measurements Official Statement of the European Respiratory Society. Eur Respir J 1995;8:492–506.
7. Janssens JP. Aging of the respiratory system: Impact on pulmonary function tests and adaptation to exertion. Clin Chest Med 2005;26:469–84.
8. Meyer KC. Aging. Proc Am Thorac Soc 2005;2:433–9.
9. Sprung J, Gajic O, Warner DO. Review article: Age related alterations in respiratory function – Anesthetic considerations. Can J Anaesth 2006;53:1244–57.
10. Stanojevic S, Wade A, Stocks J, Hankinson J, Coates AL, Pan H, et al. Reference ranges for spirometry across all ages: A new approach. Am J Respir Crit Care Med 2008;177:253–60.
11. Colloca G, Santoro M, Gambassi G. Age-related physiologic changes and perioperative management of elderly patients. Surg Oncol 2010;19:124–30.
12. 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.
13. Kerstjens HAM, Rijcken B, Scheuten JP, Postma DS. Decline of FEV1 by age and smoking status: Facts, figures, and fallacies. Thorax 1997;52:820–7.
14. 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 (1985) 1995;78:1957–68.
15. Niewoehner DE, Kleinerman J. Morphologic basis of pulmonary resistance in the human lung and effects of aging. J Appl Physiol (1985) 1974;36:412–8.
16. Stam H, Hrachovina V, Stijnen T, Versprille A. Diffusing capacity dependent on lung volume and age in normal subjects. J Appl Physiol (1985) 1994;76:2356–63.
17. Holland J, Milic-Emili J, Macklem PT, Bates DV. Regional distribution of pulmonary ventilation and perfusion in elderly subjects. J Clin Invest 1968;47:81–92.
18. Miller RM, Tenney SM. Dead space ventilation in old age. J Appl Physiol 1956;9:321–7.
19. Tolep K, Kelsen SG. Effect of aging on respiratory skeletal muscles. Clin Chest Med 1993;14:363–78.
20. Kwak H, Kim SB. Aging and Sarcopenia. J Korean Geriatr Soc 2007;11:55–9.
21. McElvaney G, Blackie S, Morrison NJ, Wilcox PG, Fairbarn MS, Pardy RL. Maximal static respiratory pressures in the normal elderly. Am Rev Respir Dis 1989;139:277–81.
22. Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in un-dernourished patients. Am Rev Respir Dis 1982;126:5–8.
23. Polkey MI, Harris ML, Hughes PD, Hamnegä rd CH, Lyons D, Green M, et al. The contractile properties of the elderly human diaphragm. Am J Respir Crit Care Med 1997;155:1560–4.
24. De Troyer A, Kirkwood PA, Wilson TA. Respiratory action of the intercostalis muscles. Physiol Rev 2005;85:717–56.
25. Enright PL, Adams AB, Boyle PJ, Sherrill DL. Spirometry and maximal respiratory pressure references from healthy Minnesota 65-to 85-ye-ar-old women and men. Chest 1995;108:663–9.
26. Peterson DD, Pack AI, Silage DA, Fishman AP. Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. Am Rev Respir Dis 1981;124:387–91.
27. Kronenberg RS, Drage CW. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest 1973;52:1812–9.
28. Poulin MJ, Cunningham DA, Paterson DH, Kowalchuk JM, Smith WD. Ventilatory sensitivity to CO2 in hyperoxia and hypoxia in older aged humans. J Appl Physiol (1985) 1993;75:2209–16.
29. Canning BJ. Encoding of the cough reflex. Pulm Pharmacol Ther 2007;20:396–401.
30. Newnham DM, Hamilton SJ. Sensitivity of the cough reflex in young and elderly subjects. Age Ageing 1997;26:185–8.

Article information Continued