““Take a deep breath” Take a deep breath”

The Ageing LungThe Ageing Lung

Aylene KelmanAylene Kelman

SpR SpR

Consideration of age in lung Consideration of age in lung functionfunction

Everyone needs to breathe!Everyone needs to breathe! Age related physiological changes in Age related physiological changes in

the lung the lung Increased duration of exposure to Increased duration of exposure to

“lung insults”“lung insults” Higher consequence on morbidity Higher consequence on morbidity

and mortalityand mortality Ageing may influence response to, Ageing may influence response to,

and treatment, of lung diseaseand treatment, of lung disease

Physiology of the ageing lungPhysiology of the ageing lung

Limitation of knowledgeLimitation of knowledge Many respiratory studies don’t Many respiratory studies don’t

include the older patient esp after include the older patient esp after the age of 80the age of 80

Is “ageing of the lung” intrinsic or Is “ageing of the lung” intrinsic or extrinsic?extrinsic?

Major changes in lung physiology Major changes in lung physiology with age or “Intrinsic ageing”with age or “Intrinsic ageing”

ReducedReduced Lung elasticityLung elasticity Respiratory muscle Respiratory muscle

strengthstrength Chest wall complianceChest wall compliance FEV1 (declines before FVC)FEV1 (declines before FVC) Bronchial hyper-Bronchial hyper-

responsivenessresponsiveness Perception of Perception of

bronchoconstrictionbronchoconstriction Diffusion capacityDiffusion capacity Arterial oxygen pressure and Arterial oxygen pressure and

saturationsaturation Ventilatory response to Ventilatory response to

hypoxia and (more hypoxia and (more worryingly) hypercapniaworryingly) hypercapnia

IncreasedIncreased Residual volumeResidual volume Lung complianceLung compliance Oxygen uptake on exerciseOxygen uptake on exercise

UnchangedUnchanged Total lung capacityTotal lung capacity Airways resistanceAirways resistance Pulmonary arterial resistancePulmonary arterial resistance Arterial CO2 levelsArterial CO2 levels

The declineThe decline

““Extrinsic lung ageing” – factors identified in Extrinsic lung ageing” – factors identified in age related decline of FEV1age related decline of FEV1

Tobacco smokingTobacco smoking Occupational exposureOccupational exposure AsthmaAsthma Atopy Atopy ObesityObesity Excessive alcohol consumptionExcessive alcohol consumption Respiratory infection in early lifeRespiratory infection in early life Nutritional status at birthNutritional status at birth Maternal or passive smokingMaternal or passive smoking

Lung CancerLung Cancer

Most common cancer in the world todayMost common cancer in the world today 2nd most common cancer diagnosis in UK, 1 in 7 of all cases2nd most common cancer diagnosis in UK, 1 in 7 of all cases Incidence peaks between 70 and 79Incidence peaks between 70 and 79 Long smoking history is main factor for increasing incidence with ageLong smoking history is main factor for increasing incidence with age

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Female casesMale ratesFemale rates

Figure 1.1: Numbers of new cases and age specific incidence rates,by sex, lung cancer, UK 2003

Lung CancerLung Cancer

Treatment led by the evidence base- but Treatment led by the evidence base- but studies of cancer treatment rarely include studies of cancer treatment rarely include the elderlythe elderly

Many treatments contraindicated because Many treatments contraindicated because of co existing morbidity (chemotherapy of co existing morbidity (chemotherapy agents can be cardiotoxic and agents can be cardiotoxic and nephrotoxic)nephrotoxic)

Several studies show that age is still a Several studies show that age is still a major factor influencing treatment choice major factor influencing treatment choice

Asthma and COPDAsthma and COPD

Asthma has been shown to be at least as Asthma has been shown to be at least as common in the elderly as in younger age common in the elderly as in younger age groupsgroups

In one study of 2000 subjects over 75, In one study of 2000 subjects over 75, 28% had experienced wheeze in the last 28% had experienced wheeze in the last 12 months and 60% had had at least one 12 months and 60% had had at least one respiratory symptomrespiratory symptom

Diagnosis can be difficult Diagnosis can be difficult Incidence of COPD rises markedly with Incidence of COPD rises markedly with

increasing ageincreasing age

Asthma and COPDAsthma and COPD

Studies show that age alone does Studies show that age alone does not influence response to treatmentnot influence response to treatment

Factors which can influence Factors which can influence treatment includetreatment include

CognitionCognition Side effects (esp steroids)Side effects (esp steroids) ComplianceCompliance Manual dexterityManual dexterity

Hindrance or help?Hindrance or help?

Respiratory infectionsRespiratory infections

Incidence of community acquired Incidence of community acquired pneumonia(CAP) substantially higher pneumonia(CAP) substantially higher in older people, especially menin older people, especially men

60% of over 70’s hospitalised with 60% of over 70’s hospitalised with CAP will die CAP will die

Age is a prognostic factor in severity Age is a prognostic factor in severity of CAP (CURB 65)of CAP (CURB 65)

Most common pathogen is still Most common pathogen is still streptococcus pneumoniaestreptococcus pneumoniae

Respiratory infections – Hospital Respiratory infections – Hospital acquired infectionacquired infection

Majority of nosocomial infections Majority of nosocomial infections happen in over 65 age grouphappen in over 65 age group

Significant proportion of these are Significant proportion of these are respiratory relatedrespiratory related

Over 60’s twice as likely to contract Over 60’s twice as likely to contract hospital acquired pneumonia as hospital acquired pneumonia as under 60’sunder 60’s

Often a terminal event for the frail Often a terminal event for the frail and elderly - “ the old man’s friend”and elderly - “ the old man’s friend”

Respiratory Infections – other Respiratory Infections – other considerationsconsiderations

TuberculosisTuberculosis InfluenzaInfluenza Aspiration pneumoniaAspiration pneumonia

DONT FORGET IMMUNISATION!DONT FORGET IMMUNISATION!

Any Questions?Any Questions?