Semin Respir Crit Care Med 2010; 31(5): 521-527
DOI: 10.1055/s-0030-1265893
© Thieme Medical Publishers

Structural and Physiological Age-Associated Changes in Aging Lungs

Martin R. Miller1
  • 1Department of Medicine, University Hospitals Birmingham NHS Trust, Nuffield House, Birmingham, United Kingdom
Further Information

Publication History

Publication Date:
12 October 2010 (online)

ABSTRACT

The tissues of the lungs undergo changes with age that lead to an increase in alveolar size without any destruction of alveolar walls. This lowers the alveolar surface tension and so reduces the elastic recoil of the lungs, which in turn causes a reduction in maximum achievable flow in the airways during the breathing cycle. Muscle performance diminishes with age and the chest wall becomes stiffer, which together lead to an increased residual volume and also counter the possible increase in total lung capacity (TLC) from the reduced elastic recoil. Exercise performance falls with age, with a small decrease in arterial oxygenation that stabilizes over the age of 70 years. Predicting lung function for the elderly is not easy, and basing clinical decisions on percent of predicted may lead to age, sex, and height bias. Focusing on what function remains can allow survival predictions to guide decisions on treatment options.

REFERENCES

  • 1 Kirkwood T B. Understanding the odd science of aging.  Cell. 2005;  120 437-447
  • 2 Ito K, Barnes P J. COPD as a disease of accelerated lung aging.  Chest. 2009;  135 173-180
  • 3 Hogg J C, Chu F, Utokaparch S et al.. The nature of small-airway obstruction in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 2645-2653
  • 4 The definition of emphysema. Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases workshop.  Am Rev Respir Dis. 1985;  132 182-185
  • 5 Saetta M, Shiner R J, Angus G E et al.. Destructive index: a measurement of lung parenchymal destruction in smokers.  Am Rev Respir Dis. 1985;  131 764-769
  • 6 Verbeken E K, Cauberghs M, Mertens I, Clement J, Lauweryns J M, Van de Woestijne K P. The senile lung: comparison with normal and emphysematous lungs, I: Structural aspects.  Chest. 1992;  101 793-799
  • 7 Verbeken E K, Cauberghs M, Mertens I, Clement J, Lauweryns J M, Van de Woestijne K P. The senile lung: comparison with normal and emphysematous lungs, II: Functional aspects.  Chest. 1992;  101 800-809
  • 8 Gillooly M, Lamb D. Airspace size in lungs of lifelong non-smokers: effect of age and sex.  Thorax. 1993;  48 39-43
  • 9 Turner J M, Mead J, Wohl M E. Elasticity of human lungs in relation to age.  J Appl Physiol. 1968;  25 664-671
  • 10 Babb T G, Rodarte J R. Mechanism of reduced maximal expiratory flow with aging.  J Appl Physiol. 2000;  89 505-511
  • 11 Pierce J A, Ebert R V. Fibrous network of the lung and its change with age.  Thorax. 1965;  20 469-476
  • 12 Tenney S DM. A tangled web: Young, Laplace and the surface tension laws.  News Physiol Sci. 1993;  8 179-183
  • 13 Bachofen H, Hildebrandt J, Bachofen M. Pressure-volume curves of air- and liquid-filled excised lungs-surface tension in situ.  J Appl Physiol. 1970;  29 422-431
  • 14 Rebello C M, Jobe A H, Eisele J W, Ikegami M. Alveolar and tissue surfactant pool sizes in humans.  Am J Respir Crit Care Med. 1996;  154(3 Pt 1) 625-628
  • 15 Gillooly M, Lamb D. Airspace size in lungs of lifelong non-smokers: effect of age and sex.  Thorax. 1993;  48 39-43
  • 16 Verbeken E K, Cauberghs M, Mertens I, Clement J, Lauweryns J M, Van de Woestijne K P. The senile lung: comparison with normal and emphysematous lungs, II: Functional aspects.  Chest. 1992;  101 800-809
  • 17 Forrest J B. The effect of changes in lung volume on the size and shape of alveoli.  J Physiol. 1970;  210 533-547
  • 18 Janssens J P, Pache J C, Nicod L P. Physiological changes in respiratory function associated with ageing.  Eur Respir J. 1999;  13 197-205
  • 19 Bouhuys A, Jonson B. Alveolar pressure, airflow rate, and lung inflation in man.  J Appl Physiol. 1967;  22 1086-1100
  • 20 Babb T G, Rodarte J R. Mechanism of reduced maximal expiratory flow with aging.  J Appl Physiol. 2000;  89 505-511
  • 21 Dawson S V, Elliott E A. Wave-speed limitation on expiratory flow-a unifying concept.  J Appl Physiol. 1977;  43 498-515
  • 22 Leblanc P, Ruff F, Milic-Emili J. Effects of age and body position on “airway closure” in man.  J Appl Physiol. 1970;  28 448-451
  • 23 McCarthy D S, Spencer R, Greene R, Milic-Emili J. Measurement of “closing volume” as a simple and sensitive test for early detection of small airway disease.  Am J Med. 1972;  52 747-753
  • 24 Murray P M, Weinstein S L, Spratt K F. The natural history and long-term follow-up of Scheuermann kyphosis.  J Bone Joint Surg Am. 1993;  75 236-248
  • 25 Mittman C, Edelman N H, Norris A H, Shock M W. Relationship between chest wall and pulmonary compliance and age.  J Appl Physiol. 1965;  20 1211-1216
  • 26 Hankinson J L, Odencrantz J R, Fedan K B. Spirometric reference values from a sample of the general U.S. population.  Am J Respir Crit Care Med. 1999;  159 179-187
  • 27 Crapo R O, Morris A H, Clayton P D, Nixon C R. Lung volumes in healthy nonsmoking adults.  Bull Eur Physiopathol Respir. 1982;  18 419-425
  • 28 Miller A, Thornton J C, Warshaw R, Anderson H, Teirstein A S, Selikoff I J. Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state: predicted values, lower limits of normal, and frequencies of abnormality by smoking history.  Am Rev Respir Dis. 1983;  127 270-277
  • 29 Rantanen T, Guralnik J M, Foley D et al.. Midlife hand grip strength as a predictor of old age disability.  JAMA. 1999;  281 558-560
  • 30 Enright P L, Kronmal R A, Manolio T A, Schenker M B, Hyatt R E. Cardiovascular Health Study Research Group . Respiratory muscle strength in the elderly: correlates and reference values.  Am J Respir Crit Care Med. 1994;  149(2 Pt 1) 430-438
  • 31 Enright P L, Adams A B, Boyle P J, Sherrill D L. Spirometry and maximal respiratory pressure references from healthy Minnesota 65- to 85-year-old women and men.  Chest. 1995;  108 663-669 , erratum 1776
  • 32 Polkey M I, Harris M L, Hughes P D et al.. The contractile properties of the elderly human diaphragm.  Am J Respir Crit Care Med. 1997;  155 1560-1564
  • 33 Tolep K, Higgins N, Muza S, Criner G, Kelsen S G. Comparison of diaphragm strength between healthy adult elderly and young men.  Am J Respir Crit Care Med. 1995;  152 677-682
  • 34 Cerveri I, Zoia M C, Fanfulla F et al.. Reference values of arterial oxygen tension in the middle-aged and elderly.  Am J Respir Crit Care Med. 1995;  152 934-941
  • 35 Hardie J A, Vollmer W M, Buist A S, Ellingsen I, Mørkve O. Reference values for arterial blood gases in the elderly.  Chest. 2004;  125 2053-2060
  • 36 Wagner P D, Laravuso R B, Uhl R R, West J B. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2.  J Clin Invest. 1974;  54 54-68
  • 37 Cardús J, Burgos F, Diaz O et al.. Increase in pulmonary ventilation-perfusion inequality with age in healthy individuals.  Am J Respir Crit Care Med. 1997;  156(2 Pt 1) 648-653
  • 38 Derion T, Guy H J, Tsukimoto K et al.. Ventilation-perfusion relationships in the lung during head-out water immersion.  J Appl Physiol. 1992;  72 64-72
  • 39 McConnell A K, Davies C T. A comparison of the ventilatory responses to exercise of elderly and younger humans.  J Gerontol. 1992;  47 B137-B141
  • 40 McConnell A K, Semple E S, Davies C T. Ventilatory responses to exercise and carbon dioxide in elderly and younger humans.  Eur J Appl Physiol Occup Physiol. 1993;  66 332-337
  • 41 Brischetto M J, Millman R P, Peterson D D, Silage D A, Pack A I. Effect of aging on ventilatory response to exercise and CO2.  J Appl Physiol. 1984;  56 1143-1150
  • 42 Poulin M J, Cunningham D A, Paterson D H, Rechnitzer P A, Ecclestone N A, Koval J J. Ventilatory response to exercise in men and women 55 to 86 years of age.  Am J Respir Crit Care Med. 1994;  149(2 Pt 1) 408-415
  • 43 McClaran S R, Babcock M A, Pegelow D F, Reddan W G, Dempsey J A. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults.  J Appl Physiol. 1995;  78 1957-1968
  • 44 Douglas N J, White D P, Weil J V, Pickett C K, Zwillich C W. Hypercapnic ventilatory response in sleeping adults.  Am Rev Respir Dis. 1982;  126 758-762
  • 45 Bixler E O, Vgontzas A N, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men, I: Prevalence and severity.  Am J Respir Crit Care Med. 1998;  157 144-148
  • 46 Browne H AK, Adams L, Simonds A K, Morrell M J. Aging does not influence the sleep-related decrease in the hypercapnic ventilatory response.  Eur Respir J. 2003;  21 523-529
  • 47 Hankinson J L, Odencrantz J R, Fedan K B. Spirometric reference values from a sample of the general U.S. population.  Am J Respir Crit Care Med. 1999;  159 179-187
  • 48 van Pelt W, Borsboom G JJM, Rijcken B, Schouten J P, van Zomeren B C, Quanjer P H. Discrepancies between longitudinal and cross-sectional change in ventilatory function in 12 years of follow-up.  Am J Respir Crit Care Med. 1994;  149 1218-1226
  • 49 Quanjer P H, Tammeling G J, Cotes J E et al.. Lung volumes and forced ventilatory flows. Report Working Party Standardisation of Lung Function Tests, European Community for Steel and Coal.  Eur Respir J. 1993;  6(Suppl 16) 5-40
  • 50 Miller M R, Pedersen O F. New concepts for expressing forced expiratory volume in lungs arising from survival analysis.  Eur Respir J. 2010;  35 873-882
  • 51 Miller M R, Pedersen O F, Dirksen A. A new staging strategy for chronic obstructive lung disease.  Int J Chron Obstruct Pulmon Dis. 2007;  2 657-663
  • 52 Chinn S, Gislason T, Aspelund T, Gudnason V. Optimum expression of adult lung function based on all-cause mortality: results from the Reykjavik study.  Respir Med. 2007;  101 601-609
  • 53 Miller M R, Pedersen O F, Lange P, Vestbo J. Improved survival prediction from lung function data in a large population sample.  Respir Med. 2009;  103 442-448

Martin R MillerB.Sc. M.D. 

Department of Medicine, University Hospitals Birmingham NHS Trust

5th Fl., Nuffield House, Birmingham B15 2TH, UK

Email: martin.miller@uhb.nhs.uk

    >