Your respiratory system is the network of organs and tissues that help you breathe.

This system
helps your body absorb oxygen from the air so your organs can work. It also cleans
waste gases, such as carbon dioxide, from your blood. Common problems include allergies,
diseases or infections.

Collectively, the normal aging process changes the anatomical structures and tissue properties
affecting respiratory physiological features in several aspects. Most important, expiratory flow rates
decrease with age, as does the partial pressure of arterial oxygen. Both of these functional variables
have been reported as risk factors for pulmonary complications.

Like the cardiovascular system, the biggest change is in the efficiency, in this case, of gas exchange.
Under usual conditions, this has little or no effect on the performance of customary life activities.
However, when an individual is confronted with a sudden demand for increased oxygen, a respiratory
deficit may occur. The body is not as sensitive to low oxygen levels or elevated carbon dioxide levels,
each indicating the need to increase the rate of breathing.

Respiratory muscle strength decreases with age and can impair effective cough, which is important for
airway clearance. The lung matures by age 20–25 years, and thereafter aging is associated with
progressive decline in lung function.

Lung volumes depend on body size, especially height. Total lung capacity (TLC) corrected for age
remains unchanged throughout life. Functional residual capacity and residual volume increase with
age, resulting in a lower vital capacity.

Lung volume

Residual volume (RV) is the air remaining in the lungs after a full, forced expiration. It is normally
around 1.2L at age 25 and gradually increases due to loss of lung elasticity. Less-elastic lungs become
more distended as they have reduced recoil during expiration; this results in air trapping. A typical 70-
year-old’s RV will have increased by some 50% to around 1.8L (Lee et al, 2016).

Vital capacity (VC) is the total volume of air that can be exhaled after a full inspiration. In an average
man aged 25, this is around 5L, declining to around 3.9L at age 65. In women, it decreases from
around 3.5L to around 2.8L (Spirduso et al, 1995). These reductions are primarily due to the gradual
increase in chest-wall rigidity and the loss of respiratory muscle strength described above. In the
average non-smoker, VC can be expected to decrease by around 200ml per decade (American Lung
Association, 2016).

Total lung capacity is the total volume of air in the lungs following a full inspiration. It is around 6L in
men and 4.2L in women and does not change significantly throughout life. It has been hypothesised
that this is because the reduced lung elasticity is counterbalanced by the increased rigidity of the
chest wall (Janssens, 2005).
Tidal volume is the amount of air exchanged during normal breathing. It is typically around 500ml
and, in the absence of pathology, does not change significantly with age. However, because of
increased chest-wall rigidity and reduction in lung elasticity, a 60-year-old will expend 20% more
energy during normal breathing than a 20-year-old (Janssens et al, 1999)

Older persons have an increased risk of developing respiratory impairment because the aging lung is
likely to have experienced exposures to environmental toxins as well as reductions in physiological
capacity.

The lungs become less able to fight infection, partly because the cells that sweep debris containing
microorganisms out of the airways are less able to do so. Cough, which also helps clear the lungs,
tends to be weaker.

Older persons have high rates of environmental exposures (21–36). For example, the current generation
of older Americans had a prior smoking rate of about 50% in the mid-1960s, which has subsequently
decreased to 9% by 2008 (27). On average, in recent cohorts of older persons, the prevalence of ever-
smokers and never-smokers is 56% and 44%, respectively (24). A history of nonsmoking, however, does
not exclude prior smoking exposure. In 2008, among nonsmoking, Americans who were ≥60 years, 32%
had a documented exposure to secondhand smoke, also known as environmental tobacco smoke (28).
Exposure to tobacco smoke, including environmental tobacco smoke, is a leading cause of chronic lung
disease (eg, chronic obstructive pulmonary disease [COPD]) as well as cardiovascular disease and cancer
(27,28).

The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR), is a person's maximum
speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a
person's ability to breathe out air. It measures the airflow through the bronchi and thus the degree of
obstruction in the airways. Peak expiratory flow is typically measured in units of liters per minute
(L/min).

https://academic.oup.com/biomedgerontology/article/67A/3/264/656517
https://www.sciencedirect.com/topics/neuroscience/peak-expiratory-flow

PEAK EXPIRATORY FLOW

Peak expiratory flow (PEF) is the maximum flow achieved during a forced expiration starting from the
level of maximal lung inflation.37 Primarily a measure of large airway caliber, PEF can be used to identify
and assess airflow limitation in clinical practice and epidemiologic studies and can aid in the monitoring
of disease progress and the effects of treatment.

In healthy subjects, PEF is determined by lung volume, airway caliber, lung elastic recoil, expiratory
muscle strength, and the duration of pause at TLC before forced expiration. Traditionally, PEF was not
thought to be flow limited because a plateau is not seen on isovolume pressure-flow curves, presumably
because of the inability of the respiratory muscles to generate sufficient force. More recently, it has
been demonstrated that PEF is determined by a wave-speed (

ws) flow-limiting mechanism in the central airways, occurring when the velocity of the accelerating flow
reaches

ws at some point in the airway.38 The three main contributing factors to PEF in this model are Pel, the
resistance upstream of the flow-limiting segment (Pfr), and the relationship between distending
pressure and airway cross-sectional area (A) at the most upstream position at which

equals

ws. According to this model, PEF will be large when Pel is large, Pfr is small, A is large, and airway wall
compliance is small. Breath-hold at TLC before performance of the expiratory maneuver results in stress-
relaxation of the viscoelastic elements of the lung and decreased airway wall compliance, reducing the
maximum achievable wave speed and thus PEF.39

Flow limitation at PEF does not mean that it is independent of effort. The magnitude of PEF depends on
how this maximum flow is reached. If expired volume from the TLC at which PEF is reached is small, PEF
will be higher because at higher lung volume, the higher elastic recoil pressure and lower upstream
resistance result in a greater wave speed and a higher PEF. In any interpretation of changes in PEF, the
magnitude of effort and the volume at which PEF is reached are critical.

Miniature PEF meters are cheap and portable and can be used in the home, but there is little evidence
to suggest that home PEF monitoring improves clinical outcomes. Issues with equipment accuracy,
compliance, and lack of technical expertise all contribute to the unreliability of home PEF monitoring,
and evidence suggests that patient education and symptom monitoring may be more useful in disease
management.40

PEF increases with height during childhood; however, there is a wide range of normal values at any
given height, making expression of a measured PEF as a percentage of predicted normal based on
population studies unlikely to be useful. PEF may be more usefully expressed relative to each child's
“personal best” determined by monitoring it for 1 to 2 weeks at a time when the child is well. This value
can then be used as a basis for comparison during exacerbations of asthma.

The alveolar dead space increases with age, affecting arterial oxygen without impairing the carbon
dioxide elimination. The airways receptors undergo functional changes with age and are less likely to
respond to drugs used in younger counterparts to treat the same disorders.

There is homogeneous degeneration of the elastic fibers around the alveolar duct starting around 50
years of age resulting in enlargement of airspaces. Reduction in supporting tissue results in premature
closure of small airways during normal breathing and can potentially cause air trapping and
hyperinflation, hence “senile emphysema”.

Older adults have decreased sensation of dyspnea and diminished ventilatory response to hypoxia and
hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, heart
failure, pneumonia, etc) and possible poor outcomes.

There is marked variation in the effect of aging on lung function. Aging is associated with reduction in
chest wall compliance and increased air trapping. The decline in FEV1 with age likely has a nonlinear
phase with acceleration in rate of decline after age 70 years. There is an increase in airspace size with
aging resulting from loss of supporting tissue. Respiratory muscle strength decreases with age and much
more so in men than in women (Table (Table6).6). Despite these changes the respiratory system is
capable of maintaining adequate oxygenation and ventilation during the entire life span. However, the
respiratory system reserve is limited with age, and diminished ventilatory response to hypoxia and
hypercapnia makes it more vulnerable to ventilatory failure during high demand states (ie, heart failure,
pneumonia, etc) and possible poor outcomes. Moreover, the reduced perception of bronchial
constriction may result in delayed medical attention. Sustained inflammation of the lower respiratory
tract may predispose older adults to increased susceptibility to toxic environmental exposure and
accelerated lung function decline. As Americans are getting older, future studies need to address the
clinical implication of “normal” age-related changes of the respiratory system.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695176/#:~:text=Respiratory%20muscle%20strength
%20decreases%20with,progressive%20decline%20in%20lung%20function.

Because of its progressive nature and with increased age as a leading factor, there
is a greater prevalence of COPD in adults 65 years of age or older. The good news is
that many adults can easily reduce their risk of COPD through lifestyle management. 
The American Lung Association estimates that between 80-90% of COPD cases are the
result of smoking. Unsurprisingly, secondhand smoke is a significant risk factor as well.
Research also suggests that there may be a link between poor air quality and COPD.

Seniors should take the following steps to reduce their risk of COPD:

 Older adults that smoke should get support from a primary care physician and
take steps to quit. There are many programs, services and products that can help.
 Seniors should avoid contact with secondhand smoke whenever possible.
 Reducing exposure to air pollution can help reduce symptoms. Many cities
issue poor air quality warnings – when these warnings are in effect, seniors should
limit outside activities. 
 Seniors should avoid airborne irritants (chemicals, fumes, etc.) in the home.
 A healthy diet and exercise plan, with direction from a physician, can improve
lung function and overall health.
 Older adults should understand the impact of aging on their respiratory
system and how to reduce their risk of any related diseases, illnesses, or
conditions.
 Doctors may recommend getting vaccinations for both influenza and
pneumococcal pneumonia in order to guard against further breathing
complications

Maintaining a healthy respiratory system

Regular exercise is essential to help maintain a healthy respiratory system. Recent studies indicate
that this exercise does not need to be intense. Yoga appears to be effective in improving lung
function: in Kadu and Deshpande’s (2013) study, middle-aged men who had done six months of yoga
had significantly increased VCs and reduced breathing rates compared with those who had not done any
yoga.

Since the efficiency of the respiratory system declines and the risk of respiratory tract diseases
increases with age, it is important to encourage older patients to pay closer attention to their
respiratory health, and to seek advice should they notice any changes in their respiratory function.

The muscles used in breathing, the diaphragm and muscles between the ribs, tend to weaken. The
number of air sacs (alveoli) and capillaries in the lungs decreases. Thus, slightly less oxygen is absorbed
from air that is breathed in. The lungs become less elastic. In people who do not smoke or have a lung
disorder, these changes do not affect ordinary daily activities, but these changes may make exercising
more difficult. Breathing at high altitudes (where there is less oxygen) may also be harder.

What are the parts of the respiratory system?

The respiratory system has many different parts that work together to
help you breathe. Each group of parts has many separate
components.

Your airways deliver air to your lungs. Your airways are a complicated
system that includes your:

 Mouth and nose: Openings that pull air from outside your body
into your respiratory system.
 Sinuses: Hollow areas between the bones in your head that
help regulate the temperature and humidity of the air you inhale.
 Pharynx (throat): Tube that delivers air from your mouth and
nose to the trachea (windpipe).
 Trachea: Passage connecting your throat and lungs.
 Bronchial tubes: Tubes at the bottom of your windpipe that
connect into each lung.
 Lungs: Two organs that remove oxygen from the air and pass it
into your blood.

From your lungs, your bloodstream delivers oxygen to all your organs
and other tissues.

Muscles and bones help move the air you inhale into and out of your
lungs. Some of the bones and muscles in the respiratory system
include your:

 Diaphragm: Muscle that helps your lungs pull in air and push it

out
 Ribs: Bones that surround and protect your lungs and heart
When you breathe out, your blood carries carbon dioxide and other
waste out of the body. Other components that work with the lungs and
blood vessels include:

 Alveoli: Tiny air sacs in the lungs where the exchange of oxygen

and carbon dioxide takes place.
 Bronchioles: Small branches of the bronchial tubes that lead to
the alveoli.
 Capillaries: Blood vessels in the alveoli walls that move oxygen
and carbon dioxide.
 Lung lobes: Sections of the lungs – three lobes in the right lung
and two in the left lung.
 Pleura: Thin sacs that surround each lung lobe and separate
your lungs from the chest wall.

Some of the other components of your respiratory system include:

 Cilia: Tiny hairs that move in a wave-like motion to filter dust and

other irritants out of your airways.
 Epiglottis: Tissue flap at the entrance to the trachea that closes
when you swallow to keep food and liquids out of your airway.
 Larynx (voice box): Hollow organ that allows you to talk and
make sounds when air moves in and out.

How can I keep my respiratory system healthy?

Being able to clear mucus out of the lungs and airways is important for
respiratory health.

To keep your respiratory system healthy, you should:

 Avoid pollutants that can damage your airways, including
secondhand smoke, chemicals, and radon (a radioactive gas
that can cause cancer). Wear a mask if you are exposed to
fumes, dust or other types of pollutants for any reason.
 Avoid smoking yourself. Don't smoke.
 Eat a healthy diet with lots of fruits and vegetables and drink
water to stay hydrated
 Exercise regularly to keep your lungs healthy.
 Prevent infections by washing your hands often and getting a flu
vaccine each year.