Pulmonary Disease

A multitude of changes occur in the lung with normal aging. There are age-related immune defects called “immunosenescence” and age-associated inflammation or “inflammaging.” Elevated levels of pro-inflammatory cytokines and increased airway neutrophils can be seen in healthy elderly adults. Structural changes occur in the aging lung and thoracic cage that result in reduced lung function. These include a loss of elastic recoil of the lung, stiffening of the chest wall, as well as kyphosis of the spine. Furthermore, genetic damage results from a lifetime of exposure to external insults and processes that stabilize and repair DNA are impaired. One notable example is telomere attrition, a feature of normal aging, but is also implicated in several diseases such as emphysema and pulmonary fibrosis. Epigenetic changes that affect gene expression are also strongly implicated in chronic lung diseases and lung cancer. The main chronic lung diseases seen in the elderly population are asthma, chronic obstructive pulmonary disease, and interstitial lung disease such as idiopathic pulmonary fibrosis (IPF). Optimal management of chronic diseases in the elderly take into the account the severity of disease, the patient’s functional capacity, and personal preferences. As comorbidities are common in this population, competing risks of other illness must be considered when therapeutic choices are made. A person-centered approach to each disease state is essential for the patient and often the family caregiver.