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Learning Objectives
Identify the structural, physiologic, and cellular changes of the lung with age.
Describe how aging processes relate to lung diseases in older patients.
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Key Clinical Points
Pulmonary function declines over time in healthy individuals leading to changes in oxygenation, ventilation, and the ability to fight infections.
Lung disease impacts pulmonary function and can accelerate pulmonary age-related decline.
Changes in the immune system with aging lead to decreased response to antigens and a proinflammatory state, which increases the risk for severe lung infections.
Best practices for pulmonary care of older patients includes avoidance of tobacco products and environmental pollution, maintaining ideal body weight, considering appropriate vaccinations, and if hypoxic, oxygen supplementation.
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Respiratory function is the interplay between the functioning of the lung tissue itself, the airways, the muscles of respiration, and the bones and joints of the thorax. In addition, the respiratory system interacts closely with other organs like the heart. Changes in each and all of these different parts ultimately affect how one breathes. By understanding how each of these parts changes with aging, one can understand how the respiratory system as a whole changes with time.
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Embryonic growth and development of the lung is a complex process, and after birth the development of the lung continues. Just as the normal body grows into young adulthood, the lungs and their function progress as well. Eventually, however, the lungs reach their peak capacity, usually well above the requirements needed for normal respiratory functioning. With normal aging, the pulmonary function declines as lung tissue, chest wall, and muscles change over time. For many patients, this decline never reaches the threshold of meaningful pulmonary disease (Figure 80-1). However, in other individuals, the accumulated insults and injuries lead to an accelerated aging process and pulmonary disease that can lead to breathlessness, decreased exercise capacity, and eventually death. Thus, when considering the aging process of a person’s lung, one must take into account their childhood lung development, the cumulative burden of lung damage that they have incurred already, and any factors that may accelerate the decline in the lung function.
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CELLULAR LUNG CHANGES WITH AGING
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The lung undergoes many cellular changes over time. These changes are the result both of the natural aging process as well as the fact that the lung is continually exposed to a range of stress insults, particularly from the external environment. Eventually the cells of the lung lose the ability to divide and differentiate ...