Abstract
The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways. By integrating clinical data together with morphologic and morphometric findings clinicians can assess the airways with a more comprehensive perspective, helpful in the interpretation of the “grey zone” between normal aging and disease. This review focuses on the value of a multidimensional approach in the study of the aging airways, including clinical findings, respiratory function tests, and imaging as parts of a whole. Nowadays this multidimensional diagnostic approach can be used in daily clinical practice. In next future, it can be implemented by the analysis of exhaled gases, post-processing imaging techniques, and genetic analysis, that will hopefully reduce the gaps in knowledge of normal aging and airway disease in older people.
Highlights
The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways
Clinical evaluation together with pulmonary function tests (PFTs) is necessary to characterize the pattern of airway disease as well as its severity
Patients with an obstructive pattern at PFTs with lower airway disease need to be studied by computed tomography (CT) scan, as it can reveal bronchiolitis, bronchiectasis, bronchial thickening in cardiac failure, as well as chronic obstructive pulmonary disease (COPD) with its specific phenotype
Summary
The aging process of the airways manifests with many features, ranging from a decrease in dynamic lung volumes and mucociliary clearance to an increase in bronchial responsiveness. In the “Eclipse” study a dramatic inter-individual variability in the yearly decline of forced expiratory volume in 1 second (FEV1) has been observed in patients with chronic obstructive pulmonary disease (COPD) (mean age 63±7, range 40-75 years) [9]. Aging is characterized by weakened pulmonary immune defenses and dramatically decreased mucociliary clearance [3] These changes result in an increased susceptibility to lung infections as well as in an increase in incidentally found imaging findings, such as bronchiectases, cysts, scars, and bronchial dilation. Patients with an obstructive pattern at PFTs with lower airway disease need to be studied by CT scan, as it can reveal bronchiolitis, bronchiectasis, bronchial thickening in cardiac failure, as well as COPD with its specific phenotype. MDCT scans allow generating 2D multiplanar and 3D reconstructions of the airways
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