Abstract
Anatomical and physiologic evidence for pulmonary problems most prevalent in the aged is reviewed. The lungs begin to age in utero. True aging must be distinguished from chronic environmental damage. The lung is essentially an “outdoor organ” vulnerable to the environment. Biochemically, aging is caused by both endogenous and exogenous free radical injury, inflicted by an over-balance of oxidants with respect to anti-oxidants. Glucose may also play a role in the aging process, by binding non-enzymatically with proteins in lung to form irreversible advanced glycosylation end-products. Physiological age-related lung changes result in: decreasing lung volumes and maximal rates of airflow; decreasing forced vital capacity (accelerated in smokers); hyperinflation (confirmed by the increased RV/TLC ratio); increased closing volume or capacity; decreased diffusing capacity; and hyporesponsive respiratory center and peripheral chemoreceptors. The clinical consequence of these age-related changes in the lung is disease in the elderly. Lung cancer and emphysema also occur as a result of chronic exposure to cigarette smoke and other environmental pollutants. Age-dependent pulmonary changes combine with non-pulmonary age-prevalent changes to cause additional diseases. Bacterial pneumonias, aspiration pneumonia, tuberculosis, and pulmonary thromboembolism are examples of these.
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