Changes in respiratory

system observed in
Elderly
 Slower response to
Decreased effective
decrease in PaO2 or
cough reflux
increase in PaCO2

Decreased
ability to clear
Bonny changes mucous
Scoliosis -+ scoliosis

Decreased
Immunity
Loss of lung
elasticity

Decreased cardiac
performance
Decreased muscle
strenghth

25% decrease in
diaphragmatic performance
 Asthma in elderly
• Second peak, affecting 4% to 8% of the
population above the age of 65 years, females
are affected more than males

• Affects quality of life and results in a higher

hospitalization rate and mortality

• >50% of total asthma fatalities annually

• Neutrophil- predominant (TH1) non- atopic

• Faster decline in lung function and a low

remission rate

• Impossible to distinguish asthma from COPD

in many patients.

• (FEV1)/ (FVC) of 70% used in a younger

 Risk factors
• Active and passive cigarette smoking
• Hormone replacement therapy
• Use of ASA, nonsteroidal anti- inflammatory
drugs (NSAIDs), angiotensin- converting
enzyme (ACE) inhibitors and beta- blockers,
including topical preparations.
• Use of paracetamol is a questionable risk
factor. Glutathione depletion in the airways
and increased oxidative stress may be the
mechanism underlying the link between
 Problems
•Delayed appearance of symptoms
•The presence of multiple comorbidities
•Dementia
•Poor eyesight
•Noncompliance
•Lack of social and family support
•Inability to distinguish asthma from other
medical conditions such as
COPD
COP
After CA and heart disease a 3rd cause of mortality

ACOS is estimated to be present in 15% to 45% of

patients with obstructive airway Disease

The GOLD staging system might misclassify up to 28%

of elderly

Fixed FEV1/ FVC ratio of 0.7 may result in

overdiagnosis of COPD
 Factors adversely affecting COPD
Sarcopenia of respiratory and larger muscle

Malnutrition 30% of COPD ( Skeletal muscle

wasting is associated with a poor prognosis) is an
independent risk factor for mortality and increased
hospitalization risk.
Chronic systemic inflammation in COPD may be
partly responsible for conditions such as muscle
wasting, heart disease, and osteoporosis

Corticosteroids used in COPD can worsen muscle

weakness

Anemia due to malnutrition in the elderly can worsen

dyspnea
Depression, anxiety, chronic pain, and social isolation
can worsen the subjective experience of dyspnea

Polypharmacy

Antihypertensives and antidepressants can cause

postural hypotension and interfere with aerobic activity;

Corticosteroids may cause muscle weakness

Opioids and benzodiazepines may reduce ventilatory

drive