Aging changes in the lungs

Information

The lungs have two primary finctions: acquire oxygen from the air, which is required for life, and to remove carbon dioxide from the body, which is a byproduct of many of the chemical reactions that sustain life.

During breathing, air enters and exits the lungs. It flows in through increasingly small airways, finally filling tiny sacs called alveoli. Blood circulates around the alveoli through capillaries. Where the capillaries and alveoli meet, oxygen crosses into the bloodstream. At the same time, carbon dioxide crosses from the bloodstream into the alveoli to be exhaled.

The lungs are continuously being exposed to particles in the air, including smoke, pollen, dust, and microorganisms. Therefore, another a major function of the lungs is to protect from any diseases that may caused by inhaled particles.

AGING CHANGES
An average person continues to slowly make new alveoli until about age 20. After this age, the lungs begin to lose some of their tissue. The number of alveoli decreases, and there is a corresponding decrease in lung capillaries. The lungs also become less elastic due to various factors including the loss of a tissue protein called elastin.

Changes in the bones and muscles result in a slightly increased front-to-back chest diameter. Loss of bone mass in the ribs and vertebrae, and mineral deposits in the rib cartilage, change the spine curvature. There may be side-to-side curvature (kyphosis) or increased front-to-back curvature (scoliosis) or lordosis.

The maximal force one can generate on inspiration or expiration decreases with age, as the diaphragm and muscles between the ribs (intercostals) become weaker. The chest is less able to stretch to breathe, and the pattern of breathing may change slightly to compensate for decreased ability to expand the chest.

EFFECT OF CHANGES
Maximum lung function decreases with age. The amount of oxygen diffusing from the air sacs into the blood decreases, the rate of air flow through the airways slowly declines after age 30, and the maximal force one is able to achieve on inspiration and expiration decreases. Usual breathing should remain adequate, and even a very old person should, under most circumstances, be able to breathe without effort.

However, when there is a need for increased breathing, the lungs may not be able to keep up with the demand. As aging continues, there may be a decreased capacity for exercise, and high altitude may cause problems.

An important change for many older people is that the airways close more readily. The airways tend to collapse when an older person breathes shallowly or when in bed for a prolonged time. Breathing shallowly because of pain, illness, or surgery causes an increased risk for pneumonia or other lung problems. As a result, it is important for older people to be out of bed as much as possible, even when ill or after surgery.

Normally, breathing is controlled by your brain. It receives information from various parts of the body telling it how much oxygen and carbon dioxide are in the blood. Low oxygen levels or high carbon dioxide levels trigger an increased rate and depth of breathing. It is normal for even healthy older people to have a reduced response to both decreased oxygen and increased carbon dioxide levels.

The voice box (larynx) also changes with aging. This causes the pitch, loudness, and quality of the voice to change. The voice may become quieter and slightly hoarse. The pitch may be decreased in women and increased in men. The voice may sound “weaker,” but most people remain quite capable of effective communication. Some people may be emotionally sensitive to the voice’s perceived loss of appeal or effectiveness.

COMMON PROBLEMS
Elderly people are at increased risk for lung infections. The body has many ways to protect against lung infections. With aging, these defenses may weaken.

The cough reflex may not trigger as readily, and the cough may be less forceful. The hairlike projections that line the airway (cilia) are less able to move mucus up and out of the airway. In addition, the nose and breathing passages secrete less of a substance called IgA (an antibody that protects against viruses). Thus, the elderly are more susceptible to pneumonia and other types of lung infections.

Common lung problems in the elderly include chronically low oxygen levels (reducing tolerance to illness), decreased exercise tolerance, abnormal breathing patterns including sleep apnea (episodes of no breathing during sleep), increased risk of lung infections such as pneumonia or bronchitis, and diseases caused by tobacco damage such as emphysema or lung cancer.

PREVENTION
Avoidance of smoking is the most important way to minimize the effect of aging on the lungs. Exercise and good overall fitness improve breathing capacity. Exercise tolerance can be affected by changes in the heart, blood vessels, muscles, and skeleton, as well as lung changes. However, studies have shown that exercise and training can improve the reserve capacity of the lungs.

Secondly, more than any other group the elderly need to be aware of the need to be up and about and should consciously try to increase deep breathing during illness or after surgery.

Continued use of voice helps maintain overall vocal performance.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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