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Respiratory function in an ageing population

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  18 November 2009

MR Miller  and
OF Pedersen
MR Miller*
Affiliation:
Department of Medicine, University Hospital Birmingham, UK
OF Pedersen
Affiliation:
Institute of Public Health, Department of Environmental and Occupational Medicine, University of Aarhus, Denmark
*
Address for correspondence: Dr MR Miller, Department of Medicine, University of Birmingham, Selly Oak Hospital, Birmingham B29 6JD, UK. Email: martin.miller@uhb.nhs.uk
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Summary

With more elderly people in the population there are more people surviving with lung diseases that need assessing so that the best treatment options can be chosen and delivered. Lung function is known to deteriorate with age and this is largely due to a reduction in muscle strength, an increased alveolar size leading to reduced elastic recoil, and a reduction in chest wall compliance. The processes involved are outlined together with the effects this has on normal lung function. Tests of lung function are commonly used to determine whether an individual patient's lungs are working abnormally, and using a lower limit of normal is the best method to use. The problems and solutions for defining the lower limit of normal for older subjects are discussed. If a subject's lung function is deemed abnormal from comparing their tests against a predicted value, then assessing how severe this abnormality is can be determined by using the results as per cent of predicted, or better still by relating the value to a minimum survivable limit.

Keywords

respiratory functionlung functionageingolder people
Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 3 , August 2009 , pp. 149 - 158
Copyright
Copyright © Cambridge University Press 2009

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References

1Kimura, M, Hjelmborg, J van B, Gardner, JP et al. Telomere length and mortality: a study of leukocytes in elderly Danish twins. Am J Epidemiol 2008; 167: 799–806.CrossRefGoogle ScholarPubMed
2Bernard, SM, Samet, JM, Grambsch, A, Ebi, KL, Romieu, I. The potential impacts of climate variability and change in air pollution-related health effects in the United States. Environ Health Perspect 2001; 109 (suppl 2): 199–209.Google ScholarPubMed
3Stenfors, N, Nordenhäll, C, Salvi, SS et al. Different airway inflammatory responses in asthmatic and healthy humans exposed to diesel. Eur Respir J 2004; 23: 82–86.CrossRefGoogle ScholarPubMed
4Stockley, RA.Neutrophils and the pathogenesis of COPD. Chest 2002; 121 (suppl 5): 151–55S.CrossRefGoogle ScholarPubMed
5Lee, J-H, Lee, D-S, Kim, E-K et al. Simvastatin inhibits cigarette smoking induced emphysema and pulmonary hypertension in rat lungs. Am J Respir Crit Care Med 2005; 172: 987–93.CrossRefGoogle ScholarPubMed
6Alexeeff, SE, Litonjua, AA, Sparrow, D, Vokonas, PS, Schwartz, J. Statin use reduces decline in lung function: VA Normative Aging Study. Am J Respir Crit Care Med 2007; 176: 742–47.CrossRefGoogle ScholarPubMed
7Keddissi, JI, Younis, WG, Chbeir, EA et al. The use of statins and lung function in current and former smokers. Chest 2007; 132: 1764–71.CrossRefGoogle ScholarPubMed
8Quanjer, PH, Tammeling, GJ, Cotes, JE, Pedersen, OF et al. Lung volumes and forced ventilatory flows. Report Working Party Standardisation of Lung Function Tests, European Community for Steel and Coal. Eur Respir J 1993; 6 (suppl 16), 5–40.CrossRefGoogle Scholar
9Dawson, SV, Elliott, EA. Wave-speed limitation on expiratory flow – a unifying concept. J Appl Physiol 1977; 43: 498–515.CrossRefGoogle Scholar
10Babb, TG, Rodarte, JR. Mechanism of reduced maximal expiratory flow with age. J Appl Physiol 2000; 89: 505–11.CrossRefGoogle Scholar
11Callaghan, TM, Wilhelm, KP. A review of ageing and an examination of clinical methods in the assessment of ageing skin. Part I: Cellular and molecular perspectives of skin ageing. Int J Cosmet Sci 2008; 30: 313–22.CrossRefGoogle Scholar
12Pierce, JA, Ebert, RV. Fibrous network of the lung and its change with age. Thorax 1965; 20: 469–76.CrossRefGoogle Scholar
13Bachofen, H, Hildebrandt, J, Bachofen, M. Pressure–volume curves of air and liquid filled excised lungs – surface tension in situ. J Appl Physiol 1970; 29: 422–31.CrossRefGoogle ScholarPubMed
14Tenney, SDM. A tangled web: Young, Laplace and the surface tension laws. News Physiol Sci 1993; 8: 179–83.Google Scholar
15Gillooly, M, Lamb, D. Airspace size in lungs of lifelong non-smokers: effect of age and sex. Thorax 1993; 48: 39–43.CrossRefGoogle ScholarPubMed
16Verbeken, EK, Cauberghs, M, Mertens, I et al. The senile lung. Comparison with normal and emphysematous lungs. 2. Functional aspects. Chest 1992; 101: 800–09.CrossRefGoogle ScholarPubMed
17Rebello, CM, Jobe, AH, Eisele, JW, Ikegami, M. Alveolar and tissue surfactant pool sizes in humans. Am J Respir Crit Care Med 1996; 154: 625–28.CrossRefGoogle ScholarPubMed
18Janssens, JP, Pache, JC, Nicod, LP. Physiological changes in respiratory function associated with ageing. Eur Respir J 1999; 13: 197–205.CrossRefGoogle ScholarPubMed
19Swanney, MP, Ruppel, G, Enright, PL et al. Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction. Thorax 2008; 63: 1046–51.CrossRefGoogle ScholarPubMed
20Anthonisen, NR, Danson, J, Robertson, PC, Ross, WR. Airway closure as a function of age. Resp Physiol 1969; 8: 58–65.CrossRefGoogle ScholarPubMed
21Leblanc, P, Ruff, F, Milic-Emili, J. Effects of age and body position on ‘airway closure’ in man. J Appl Physiol 1970; 28: 448–51.CrossRefGoogle ScholarPubMed
22Cerveri, I, Zoia, MC, Fanfulla, F et al. Reference values of arterial oxygen tension in the middle-aged and elderly. Am J Respir Crit Care Med 1995; 152: 934–41.CrossRefGoogle ScholarPubMed
23Hardie, JA, Vollmer, WM, Buist, AS, Ellingsen, I, Mørkve, O. Reference values for arterial blood gases in the elderly. Chest 2004; 125: 2053–60.CrossRefGoogle ScholarPubMed
24Wagner, PD, Laravuso, RB, Uhl, RR, West, JB. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100% O2. J Clin Invest 1974; 54: 54–68.CrossRefGoogle ScholarPubMed
25Rantanen, T, Guralnik, JM, Foley, D et al. Midlife hand grip strength as a predictor of old age disability. JAMA 1999; 281: 558–60.CrossRefGoogle ScholarPubMed
26Enright, PL, Kronmal, RA, Manolio, TA et al. Respiratory muscle strength in the elderly. Am J Respir Crit Care Med 1994; 149: 430–38.CrossRefGoogle ScholarPubMed
27Polkey, MI, Harris, ML, Hughes, PD et al. The contractile properties of the elderly human diaphragm. Am J Respir Crit Care Med 1997; 155: 1560–64.CrossRefGoogle ScholarPubMed
28Tolep, K, Higgins, N, Muza, S et al. Comparison of diaphragm strength between healthy adult elderly and young men. Am J Respir Crit Care Med 1995; 152: 677–82.CrossRefGoogle ScholarPubMed
29Mittman, C, Edelman, NH, Norris, AH, Shock, MW. Relationship between chest wall and pulmonary compliance and age. J Appl Physiol 1965; 20: 1211–16.CrossRefGoogle Scholar
30Ogden, CL, Carroll, MD, Curtin, LR et al. Prevalence of overweight and obesity in the United States 1999–2004. JAMA 2006; 295: 1549–55.CrossRefGoogle ScholarPubMed
31Wang, M, McCabe, L, Petsonk, EL, Hankinson, JL, Banks, DE. Weight gain and longitudinal changes in lung function in steel workers. Chest 1997; 111: 1526–32.CrossRefGoogle ScholarPubMed
32Hankinson, JL, Odencrantz, JR, Fedan, KB. Spirometric reference values from a sample of the general US population. Am J Respir Crit Care Med 1999; 152: 179–87.CrossRefGoogle Scholar
33Jacobsen, PK, Sigsgaard, T, Pedersen, OF, Christensen, K, Miller, MR. Lung function as a predictor of survival in the very elderly: the Danish 1905 cohort study. J Am Geriatr Soc 2008; 56: 2150–52.CrossRefGoogle ScholarPubMed
34Enright, PL, Adams, AB, Boyle, PJR, Sherrill, DL. Spirometry and maximal respiratory pressure references from healthy Minnesota 65- to 85-year-old women and men. Chest 1995; 108: 663–69.CrossRefGoogle ScholarPubMed
35Bartynski, WS, Heller, MT, Grahovac, SZ et al. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. Am J Neuroradiol 2005; 26: 2077–85.Google ScholarPubMed
36Glindmeyer, HW, Diem, JE, Jones, RN, Weill, H. Non-comparability of longitudinal and cross-sectionally determined annual change in spirometry. Am Rev Respir Dis 1982; 125: 544–48.CrossRefGoogle Scholar
37Ware, JH, Dockery, DW, Louis, TA et al. Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. Am J Epidemiol 1990; 132: 685–700.CrossRefGoogle ScholarPubMed
38Van Pelt, W, Borsboom, GJ, Rijken, B et al. Discrepancies between longitudinal and cross-sectional change in ventilatory function in 12 years of follow-up. Am J Respir Crit Care Med 1994; 149: 1218–26.CrossRefGoogle ScholarPubMed
39Fletcher, CM, Peto, R, Tinker, CM, Speizer, FE. The Natural History of Chronic Bronchitis and Emphysema. Oxford, Oxford University Press, 1976. ISBN 0192611194.Google Scholar
40Stanojevic, S, Wade, A, Stocks, J, Hankinson, J et al. Reference ranges for spirometry across all ages. A new approach. Am J Respir Crit Care Med 2008; 177: 253–60.CrossRefGoogle ScholarPubMed
41Bates, DV, Macklem, PT, Christie, RV. Respiratory Function in Disease, 2nd edn. Philadelphia, W.B. Saunders, 1971.Google Scholar
42Miller, MR, Pedersen, OF. New concepts for expressing FEV1 arising from survival analysis. Eur Respir J 2009 (Epub ahead of print, 9 Sept).Google Scholar
43Miller, MR, Pedersen, OF, Dirksen, A. Improved staging of chronic obstructive lung disease. Int J COPD 2007; 2: 657–63.Google Scholar
44Chinn, S, Gislason, C, Aspelund, T et al. Optimum expression of adult lung function based on all-cause mortality: results from the Reykjavik study. Resp Med 2007; 101: 601–60.CrossRefGoogle ScholarPubMed
45Miller, MR, Pedersen, OF, Lange, P, Vestbo, J. Improved survival prediction from lung function data in a large population sample. Respir Med 2009; 103: 442–8.CrossRefGoogle Scholar
46Xu, X, Weiss, ST, Dockery, DW, Schouten, JP, Rijcken, B. Comparing FEV1 in adults in two community-based surveys. Chest 1995; 108: 656–62.CrossRefGoogle Scholar