1. “Take a deep breath” The Ageing Lung Aylene Kelman SpR

2. Consideration of age in lung function  Everyone needs to breathe!  Age related physiological changes in the lung  Increased duration of exposure to “lung insults”  Higher consequence on morbidity and mortality  Ageing may influence response to, and treatment, of lung disease

3. Physiology of the ageing lung  Limitation of knowledge  Many respiratory studies don’t include the older patient esp after the age of 80  Is “ageing of the lung” intrinsic or extrinsic?

4. Major changes in lung physiology with age or “Intrinsic ageing” Reduced  Lung elasticity  Respiratory muscle strength  Chest wall compliance  FEV1 (declines before FVC)  Bronchial hyper- responsiveness  Perception of bronchoconstriction  Diffusion capacity  Arterial oxygen pressure and saturation  Ventilatory response to hypoxia and (more worryingly) hypercapnia Increased  Residual volume  Lung compliance  Oxygen uptake on exercise Unchanged  Total lung capacity  Airways resistance  Pulmonary arterial resistance  Arterial CO2 levels

5. The decline

6. “Extrinsic lung ageing” – factors identified in age related decline of FEV1  Tobacco smoking  Occupational exposure  Asthma  Atopy  Obesity  Excessive alcohol consumption  Respiratory infection in early life  Nutritional status at birth  Maternal or passive smoking

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

8. Lung Cancer  Treatment led by the evidence base- but studies of cancer treatment rarely include the elderly  Many treatments contraindicated because of co existing morbidity (chemotherapy agents can be cardiotoxic and nephrotoxic)  Several studies show that age is still a major factor influencing treatment choice

9. Asthma and COPD  Asthma has been shown to be at least as common in the elderly as in younger age groups  In one study of 2000 subjects over 75, 28% had experienced wheeze in the last 12 months and 60% had had at least one respiratory symptom  Diagnosis can be difficult  Incidence of COPD rises markedly with increasing age

10. Asthma and COPD  Studies show that age alone does not influence response to treatment  Factors which can influence treatment include  Cognition  Side effects (esp steroids)  Compliance  Manual dexterity

11. Hindrance or help?

12. Respiratory infections  Incidence of community acquired pneumonia(CAP) substantially higher in older people, especially men  60% of over 70’s hospitalised with CAP will die  Age is a prognostic factor in severity of CAP (CURB 65)  Most common pathogen is still streptococcus pneumoniae

13. Respiratory infections – Hospital acquired infection  Majority of nosocomial infections happen in over 65 age group  Significant proportion of these are respiratory related  Over 60’s twice as likely to contract hospital acquired pneumonia as under 60’s  Often a terminal event for the frail and elderly - “ the old man’s friend”

14. Respiratory Infections – other considerations  Tuberculosis  Influenza  Aspiration pneumonia  DONT FORGET IMMUNISATION!

15. Any Questions?