Seminars in respiratory and critical care medicine
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The elderly are especially prone to the adverse health effects of chronic obstructive pulmonary disease (COPD), which is a common disorder in that population. While the prevalence and morbidity of COPD in the elderly are high, it is often undiagnosed and thus undertreated. The diagnosis of COPD is primarily based on the physiological documentation of airflow limitation using spirometry. ⋯ However, management of COPD in the elderly population may be challenged by the "polypharmacy" of medications that these patients often take, which can interfere with compliance with therapy. Additionally, the elderly often suffer from physical or cognitive disabilities that can prevent compliance with prescribed medications. Lastly, adverse effects from medications prescribed for treatment of COPD may be more pervasive in elderly patients.
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Semin Respir Crit Care Med · Oct 2010
ReviewThe pulmonary circulation and exercise responses in the elderly.
Aging is associated with a progressive deterioration in the structure and function of the pulmonary circulation. Remodeling of the pulmonary vasculature occurs from maturity to senescence that is characterized by an increase in pulmonary vascular stiffness, pulmonary vascular pressures, and pulmonary vascular resistance along with increased heterogeneity of alveolar ventilation and pulmonary perfusion and decreased pulmonary capillary blood volume and membrane diffusing capacity that is consistent with a reduction in alveolar-capillary surface area. In theory, the aforementioned age-related changes in the pulmonary circulation may conspire to make elderly individuals more susceptible to gas exchange abnormalities during exercise. ⋯ A more prominent aspect of aging is the loss of lung elastic recoil that is associated with a modest reduction in the expiratory boundary of the maximal flow-volume envelope. This in turn increases the severity of expiratory airflow limitation and induces dynamic lung hyperinflation during exercise. The consequences of this age-associated decrease in elastic recoil on the pulmonary circulation are speculative, but an age-associated decline in elastic recoil may influence pulmonary vascular resistance and cardiac output, in addition to its impact on the work and oxygen cost of breathing.
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Semin Respir Crit Care Med · Oct 2010
ReviewAging and interstitial lung diseases: unraveling an old forgotten player in the pathogenesis of lung fibrosis.
Aging is a natural process characterized by a progressive functional impairment and reduced capacity to respond adaptively to environmental stimuli. Aging is associated with increased susceptibility to a variety of chronic diseases, including type 2 diabetes mellitus, cancer, and neurological diseases. ⋯ Immunosenescence, oxidative stress, abnormal shortening of telomeres, apoptosis, and epigenetic changes affecting gene expression have been proposed to contribute to the aging process, and aging-associated diseases. Here, we review the emerging concepts highlighting the putative aging-associated abnormalities involved in some human ILDs.