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      Clinical Interventions in Aging (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on prevention and treatment of diseases in people over 65 years of age. Sign up for email alerts here.

      36,334 Monthly downloads/views I 3.829 Impact Factor I 7.4 CiteScore I 1.83 Source Normalized Impact per Paper (SNIP) I 1.044 Scimago Journal & Country Rank (SJR)

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      Is Open Access

      Effect of aging on respiratory system physiology and immunology

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          Abstract

          With the looming expansion of the elderly population of the US, a thorough understanding of “normal” aging-related changes on the respiratory system is paramount. The respiratory system undergoes various anatomical, physiological and immunological changes with age. The structural changes include chest wall and thoracic spine deformities which impairs the total respiratory system compliance leading to increase work of breathing. The lung parenchyma loses its supporting structure causing dilation of air spaces: “senile emphysema”. Respiratory muscle strength decreases with age and can impair effective cough, which is important for airway clearance. The lung matures by age 20–25 years, and thereafter aging is associated with progressive decline in lung function. The alveolar dead space increases with age, affecting arterial oxygen without impairing the carbon dioxide elimination. The airways receptors undergo functional changes with age and are less likely to respond to drugs used in younger counterparts to treat the same disorders. Older adults have decreased sensation of dyspnea and diminished ventilatory response to hypoxia and hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, heart failure, pneumonia, etc) and possible poor outcomes.

          Most cited references38

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          Reference spirometric values using techniques and equipment that meet ATS recommendations.

          Forced expiratory volumes and flows were measured in 251 healthy nonsmoking men and women using techniques and equipment that meet American Thoracic Society (ATS) recommendations. Linear regression equations using height and age alone predict spirometric parameters as well as more complex equations using additional variables. Single values for 95% confidence intervals are acceptable and should replace the commonly used method of subtracting 20% to determine the lower limit of normal for a predicted value. Our study produced predicted values for forced vital capacity and forced expiratory volume in one second that were almost identical to those predicted by Morris and associates (1) when the data from their study were modified to be compatible with the back extrapolation technique recommended by the ATS. The study of Morris and colleagues was performed at sea level in rural subjects, whereas ours was performed at an altitude of 1,400 m in urban subjects. Either the present study or the study of Morris and co-workers, modified to back extrapolation, could be recommended for predicting normal values.
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            Physiological changes in respiratory function associated with ageing.

            Physiological ageing of the lung is associated with dilatation of alveoli, enlargement of airspaces, decrease in exchange surface area and loss of supporting tissue for peripheral airways ("senile emphysema"), changes resulting in decreased static elastic recoil of the lung and increased residual volume and functional residual capacity. Compliance of the chest wall diminishes, thereby increasing work of breathing when compared with younger subjects. Respiratory muscle strength also decreases with ageing, and is strongly correlated with nutritional status and cardiac index. Expiratory flow rates decrease with a characteristic alteration in the flow-volume curve suggesting small airway disease. The ventilation-perfusion ratio (V'A/Q') heterogeneity increases, with low V'A/Q' zones appearing as a result of premature closing of dependent airways. Carbon monoxide transfer decreases with age, reflecting mainly a loss of surface area. 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 arterial oxygen tension, and no significant change in arterial carbon dioxide tension. Ageing tends to diminish the reserve of the respiratory system in cases of acute disease. Decreased sensitivity of respiratory centres to hypoxia or hypercapnia results in a diminished ventilatory response in cases of heart failure, infection or aggravated airway obstruction. Furthermore, decreased perception bronchoconstriction and diminished physical activity may result in lesser awareness of the disease and delayed diagnosis.
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              Spirometric standards for healthy nonsmoking adults.

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                Author and article information

                Journal
                Clin Interv Aging
                Clinical Interventions in Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                September 2006
                September 2006
                : 1
                : 3
                : 253-260
                Affiliations
                [1 ]Division of Allergy, Pulmonary, Immunology, Critical Care, and Sleep (APICS), Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA;
                [2 ]Division of Geriatrics, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
                Author notes
                Correspondence: Gulshan Sharma, Division of Allergy, Pulmonary, Immunology, Critical care, and Sleep (APICS), Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0561, USA, Tel +1 409 772 2436, Fax +1 409 772 9532, Email gulshan.sharma@ 123456utmb.edu
                Article
                cia-0103-253
                10.2147/ciia.2006.1.3.253
                2695176
                18046878
                fda73a4a-d809-4740-87ed-e67309ac84fd
                © 2006 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Review

                Health & Social care
                immunology,older adults,respiratory mechanics,lung function
                Health & Social care
                immunology, older adults, respiratory mechanics, lung function

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