Aging of the Respiratory System: Impact on Pulmonary Function Tests and Adaptation to Exertion

Outpatient Section of the Division of Pulmonary Diseases, Geneva University Hospital, 1211 Geneva 14, Switzerland.
Clinics in Chest Medicine (Impact Factor: 2.07). 10/2005; 26(3):469-84, vi-vii. DOI: 10.1016/j.ccm.2005.05.004
Source: PubMed


Normal aging of the respiratory system is associated with a decrease in static elastic recoil of the lung, in respiratory muscle performance, and in compliance of the chest wall and respiratory system, resulting in increased work of breathing compared with younger subjects and a diminished respiratory reserve in cases of acute illness, such as heart failure, infection, or airway obstruction. In spite of these changes, the respiratory system remains capable of maintaining adequate gas exchange at rest and during exertion during the entire lifespan, with only a slight decrease in Pa(O2) and no significant change in Pa(CO2).

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    • "This is probably due to obstruction of acinary airways through the loss of alveolar attachments that stabilize these airways. Furthermore , there is a reduction in the surface of the lung available for gas exchange because of the coalescence of alveoli along with loss of alveolar walls [32]. In line with this, there is a decrease of gas transfer rates and pulmonary capillary volumes with age. "
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    ABSTRACT: It is not fully understood how the fraction of exhaled nitric oxide (FeNO) varies with age and gender in healthy individuals. We aim to describe the evolution of FeNO with age, giving special regard to the effect of gender, and to relate this evolution to natural changes in the respiratory tract. We studied 3081 subjects from NHANES 2007–08 and 2009–10, aged 6–80 years, with no self-reported diagnosis of asthma, chronic bronchitis or emphysema, and with normal values of blood eosinophils and C-reactive protein. The relationship of the mean values of FeNO to age, in all participants and divided by gender, was computed, and compared with changes in anatomic dead space volume and forced vital capacity. A change-point analysis technique and subsequent piecewise regression was used to detect breakpoints in the evolution of FeNO with age. Three distinct phases in the evolution of FeNO throughout the age range 6–80 years can be seen. FeNO values increase linearly between 6–14 years of age in girls and between 6–16 years of age in boys, in parallel with somatic growth. After that, FeNO levels plateau in both genders until age 45 years in females and age 59 years in males, when they start to increase linearly again. This increase continues until age 80. Our data clearly show a triphasic evolution of FeNO throughout the human age range in healthy individuals. This should be accounted for in development of reference equations for normal FeNO values.
    Full-text · Article · May 2015 · Journal of Breath Research
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    • "In acromegalic patients an increase in alveolar size presumably occurs due to changes in the elastic properties of the lungs, despite the lack of histopathological studies [8,13]. In the elderly, there is increased lung compliance and decreased elastic recoil pressure [44,45]. These findings are also reported in acromegalic patients [13]. "
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    ABSTRACT: Despite the gradual improvement in treatment procedures and cure rates of acromegaly, a steady increase in the mortality rate due to respiratory disease has been documented in recent decades. In this study, our objectives were to describe the abnormalities in lung structure and function that occur in acromegalic patients and to correlate these changes with hormonal levels. This cross-sectional study included 20 acromegalic patients and 20 age-and height-matched control subjects, all non-smokers. All subjects underwent spirometry, whole body plethysmography, carbon monoxide diffusing capacity, and respiratory muscle strength. Acromegalic patients also performed high-resolution computed tomography (HRCT). Most patients were female (65%), with a mean age of 52.5 +/- 13 years. Acromegalic patients showed lower values of maximum expiratory pressure (55.9 +/- 17.1 vs. 103.7 +/- 19.2%; p < 0.001) and maximum inspiratory pressure (71.4 +/- 27.8 vs. 85.3 +/- 24.1%; p = 0.005) compared to control subjects. The values of forced vital capacity (107.1 +/- 15.9 vs. 98.9 +/- 21.4%; p = 0.028), total lung capacity -- TLC (107.3 +/- 12.9 vs. 93.7 +/- 7.60%; p = 0.002), residual volume (114.1 +/- 22.7 vs. 90.0 +/- 14.6%; p < 0.001), and airways' resistance (3.82 vs. 2.31 cmH2O/L/s; p = 0.039) were greater in acromegalic patients than in control subjects. The difference between the TLC measured by plethysmography and the VA (alveolar volume) measured during the DLCO maneuver was higher in acromegalic patients than in control subjects (0.69 +/- 0.46 vs. 0.19 +/- 0.61 L; p = 0.021). The main findings in HRCT in acromegalic patients were air trapping, airway calcification and bronchiectasis, which were observed in 60%, 40% and 35% of cases, respectively. There was no significant correlation between the levels of growth hormone and insulin-like growth factor I, the lung function and the air trapping. Acromegalic patients show changes consistent with the involvement of the small airways and ventilation inhomogeneity, both in terms of lung function and structure. However, air trapping cannot be explained either by hormone levels or changes in lung function.
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    • "Age and height are the factors most closely related to vital capacity, and most previous studies also formulate their prediction equations upon these 2 variables (7-12, 14). Respiratory function declines with age, mainly because of structural changes induced by aging in the respiratory system, including the chest wall, respiratory muscle, parenchyma, and peripheral airway (23). FEV1 and FVC reach a plateau at the age of 18-25 yr, and decrease thereafter. "
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    ABSTRACT: The objective of this study was to develop new spirometric reference equations for the Korean population using the raw data of the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009). A total of 4,753 healthy lifelong nonsmokers without respiratory diseases and symptoms were selected as the reference population. Spirometric reference equations were derived through multiple regression analysis. The newly developed reference equations for spirometry parameters were as follows: FEV1 (L) = -0.00025410 × (Age [years])(2) + 0.00012644 × (Height [cm])(2) - 0.00262 × Weight (kg) + 0.61493 (Men); FEV1 (L) = -0.00017538 × Age(2) + 0.00009598 × Height(2) - 0.00231 × Weight + 0.46877 (Women); FVC (L) = -0.00000219 × Age(3) + 0.0000006995642 × Height(3) + 1.19135 (Men); FVC (L) = 0.0167 × Age - 0.00030284 × Age(2) + 0.0000005850287 × Height(3) + 0.77609 (Women); FEV1/FVC (%) = -0.00289 × Age(2) - 0.16158 × Height(3) + 114.13736 (Men); FEV1/FVC (%) = -0.21382 × Age - 0.00000143 × Height(3) + 97.62514 (Women). The newly developed spirometric reference equation in this study can be used as criteria for the interpretation of spirometry results and the diagnosis of respiratory diseases in Korean adults.
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