Kosin Med J.  2016 Jun;31(1):11-18. 10.7180/kmj.2016.31.1.11.

Aging of the respiratory system

• Lee SH
• Yim SJ
• Kim HC

• KMID: 2328714
• DOI: http://doi.org/10.7180/kmj.2016.31.1.11

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.

Keyword

Aging; Respiratory system

MeSH Terms

Aging*
Anoxia
Carbon Dioxide
Compliance
Diffusion
Energy Metabolism
Forced Expiratory Volume
Hypercapnia
Lung
Muscular Atrophy
Oxygen
Oxygen Consumption
Residual Volume
Respiratory Function Tests
Respiratory Muscles
Respiratory System*
Total Lung Capacity
Ventilation
Vital Capacity
Carbon Dioxide
Oxygen

Reference

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.