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Chapter 16 - Lungs of the Elder

Published online by Cambridge University Press:  11 July 2020

Kim A. Collins
LifePoint Inc, South Carolina
Roger W. Byard
University of Adelaide
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Aging of the respiratory system is a physiological process that occurs due to alterations within the lungs and tracheobronchial tree and structural changes of the thorax. This process is intensified not only by environmental factors including smoking but also by adverse environmental effects during childhood, parental asthma, and genetic factors.

Publisher: Cambridge University Press
Print publication year: 2020

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Skloot, GS: The effects of aging on lung structure and function. Clin Geriatr Med 2017, 33:447–57.CrossRefGoogle ScholarPubMed
Miller, MR: Structural and physiological age-associated changes in aging lungs. Semin Respir Crit Care Med 2010, 31:521–7.CrossRefGoogle ScholarPubMed
Vaz Fragoso, CA, Gill, TM: Respiratory impairment and the aging lung: a novel paradigm for assessing pulmonary function. J Gerontol A Biol Sci Med Sci 2012, 67:264–75.Google ScholarPubMed
Kado, DM, Prenovost, K, Crandall, C: Narrative review: hyperkyphosis in older persons. Ann Intern Med 2007, 147:330–8.CrossRefGoogle ScholarPubMed
Lowery, EM, Brubaker, AL, Kuhlmann, E, Kovacs, EJ: The aging lung. Clin Interv Aging 2013, 8:1489–96.Google ScholarPubMed
Guenard, H, Marthan, R: Pulmonary gas exchange in elderly subjects. Eur Respir J 1996, 9:2573–7.CrossRefGoogle ScholarPubMed
Navarro, S, Driscoll, B: Regeneration of the aging lung: a mini-review. Gerontology 2017, 63:270–80.CrossRefGoogle ScholarPubMed
Blasco, MA: Telomeres and human disease: ageing, cancer and beyond. Nat Rev Genet 2005, 6:611–22.CrossRefGoogle ScholarPubMed
Fletcher, C, Peto, R: The natural history of chronic airflow obstruction. Br Med J 1977, 1:1645–8.CrossRefGoogle ScholarPubMed
Bush, A: Lung development and aging. Ann Am Thorac Soc 2016, 13 (Suppl 5):S438–46.CrossRefGoogle ScholarPubMed
Svanes, C, Sunyer, J, Plana, E, et al: Early life origins of chronic obstructive pulmonary disease. Thorax 2010, 65:1420.CrossRefGoogle ScholarPubMed
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: 2019 Report. (accessed November 11, 2018).Google Scholar
Bahadir, A, Ortakoylu, MG, Iliaz, S, et al: Prevalence and outcomes of comorbid illnesses in elderly patients with respiratory diseases. Geriatr Gerontol Int 2016, 16:791–6.CrossRefGoogle ScholarPubMed
Scichilone, N: Comorbidities of lung disease in the elderly. Clin Geriatr Med 2017, 33:597603.CrossRefGoogle ScholarPubMed
Krauskopf, KA, Sofianou, A, Goel, MS, et al: Depressive symptoms, low adherence, and poor asthma outcomes in the elderly. J Asthma 2013, 50:260–6.CrossRefGoogle ScholarPubMed
Chan, WL, Yang, KP, Chao, TF, et al: The association of asthma and atrial fibrillation: a nationwide population-based nested case-control study. Int J Cardiol 2014, 176:464–9.CrossRefGoogle ScholarPubMed
Soriano, JB, Visick, GT, Muellerova, H, Payvandi, N, Hansell, AL: Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest 2005, 128:2099–107.CrossRefGoogle ScholarPubMed
Sorino, C, Pedone, C, Scichilone, N: Fifteen-year mortality of patients with asthma-COPD overlap syndrome. Eur J Intern Med 2016, 34:72–7.CrossRefGoogle ScholarPubMed
Raghu, G, Freudenberger, TD, Yang, S, et al: High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis. Eur Respir J 2006, 27:136–42.CrossRefGoogle ScholarPubMed
Nadrous, HF, Pellikka, PA, Krowka, MJ, et al: Pulmonary hypertension in patients with idiopathic pulmonary fibrosis. Chest 2005, 128:2393–9.CrossRefGoogle ScholarPubMed
Mejia, M, Carrillo, G, Rojas-Serrano, J, et al: Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension. Chest 2009, 136:1015.CrossRefGoogle ScholarPubMed
Raghu, G, Amatto, VC, Behr, J, Stowasser, S: Comorbidities in idiopathic pulmonary fibrosis patients: a systematic literature review. Eur Respir J 2015, 46:1113–30.CrossRefGoogle ScholarPubMed
Mukhopadhyay, S, Farver, CF, Vaszar, LT, et al: Causes of pulmonary granulomas: a retrospective study of 500 cases from seven countries. J Clin Pathol 2012, 65:51–7.CrossRefGoogle ScholarPubMed
Bongomin, F, Gago, S, Oladele, RO, Denning, DW: Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel) 2017, 3:pii: E57.Google ScholarPubMed
Araki, T, Nishino, M, Zazueta, OE, et al: Paraseptal emphysema: prevalence and distribution on CT and association with interstitial lung abnormalities. Eur J Radiol 2015, 84:1413–18.CrossRefGoogle Scholar
GBD 2016 Lower Respiratory Infections Collaborators: Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018, 18:1191–210.Google Scholar
Centers for Disease Control and Prevention (CDC) Older Persons’ Health. (accessed October 31, 2019).Google Scholar
Beasley, MB, Franks, TJ, Galvin, JR, Gochuico, B, Travis, WD: Acute fibrinous and organizing pneumonia: a histological pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med 2002, 126:1064–70.Google ScholarPubMed
Katzenstein, AL, Myers, JL, Mazur, MT: Acute interstitial pneumonia: a clinicopathologic, ultrastructural, and cell kinetic study. Am J Surg Pathol 1986, 10:256–67.CrossRefGoogle ScholarPubMed
Kalil, AC, Metersky, ML, Klompas, M, et al: Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016, 63:e61e111.CrossRefGoogle Scholar
Jones, RN: Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010, 51 (Suppl 1):S8187.CrossRefGoogle ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al: Antimicrobial-resistant pathogens associated with healthcare-associated infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016, 37:1288–301.CrossRefGoogle ScholarPubMed
Chow, EJ, Mermel, LA: Hospital-acquired respiratory viral infections: incidence, morbidity, and mortality in pediatric and adult patients. Open Forum Infect Dis 2017, 4:ofx006.CrossRefGoogle ScholarPubMed
Raghu, G, Weycker, D, Edelsberg, J, Bradford, WZ, Oster, G: Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2006, 174:810–16.CrossRefGoogle ScholarPubMed
Fell, CD, Martinez, FJ, Liu, LX, et al: Clinical predictors of a diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2010, 181:832–7.CrossRefGoogle ScholarPubMed
Patterson, KC, Shah, RJ, Porteous, MK, et al: Interstitial lung disease in the elderly. Chest 2017, 151:838–44.CrossRefGoogle ScholarPubMed
Nathan, SD, Shlobin, OA, Weir, N, et al: Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium. Chest 2011, 140:221–9.CrossRefGoogle ScholarPubMed
Ryerson, C, Ley, B: Prognosis and monitoring of idiopathic pulmonary fibrosis. In Post, TW, ed. UpToDate. Waltham, MA: UpToDate; 2018.Google Scholar
Raghu, G, Collard, HR, Egan, JJ, et al: An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011, 183:788824.CrossRefGoogle ScholarPubMed
Vaszar, LT, Larsen, BT, Swanson, KL, Ryu, JH, Tazelaar, HD: Diagnostic utility of surgical lung biopsies in elderly patients with indeterminate interstitial lung disease. Respirology 2018, 23:507–11.CrossRefGoogle ScholarPubMed
Churg, A, Wright, JL, Tazelaar, HD: Acute exacerbations of fibrotic interstitial lung disease. Histopathology 2011, 58:525530.CrossRefGoogle ScholarPubMed
Collard, HR, Moore, BB, Flaherty, KR, et al: Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2007, 176:636–43.CrossRefGoogle ScholarPubMed
Collard, HR, Ryerson, CJ, Corte, TJ, et al: Acute exacerbation of idiopathic pulmonary fibrosis. An International Working Group Report. Am J Respir Crit Care Med 2016, 194:265–75.CrossRefGoogle ScholarPubMed
Travis, WD, Colby, TV, Koss, MN, et al: Atlas of Nontumor Pathology. Non-neoplastic Disorders of the Lower Respiratory Tract. Washington, DC: American Registry of Pathology and the Armed Forces Institute of Pathology; 2002.Google Scholar
Zamora, AC, White, DB, Sykes, AM, et al: Amyloid-associated cystic lung disease. Chest 2016, 149:1223–33.CrossRefGoogle ScholarPubMed
Khoor, A, Roden, AC, Colby, TV, Roggli, VL, et al: Giant cell interstitial pneumonia in patients without hard metal exposure: analysis of 3 cases and review of the literature. Hum Pathol 2016, 50:176–82.CrossRefGoogle ScholarPubMed
Roggli, V, Gibbs, AR, Attanoos, R, et al: Pathology of asbestosis: an update of the diagnostic criteria response to a critique. Arch Pathol Lab Med 2016, 140:950–2.CrossRefGoogle ScholarPubMed
Siegel, RL, Miller, KD, Jemal, A: Cancer statistics, 2018. CA Cancer J Clin 2018, 68:730.CrossRefGoogle ScholarPubMed
Torre, LA, Bray, F, Siegel, RL, et al: Global cancer statistics, 2012. CA Cancer J Clin 2015, 65:87108.CrossRefGoogle ScholarPubMed
Torre, LA, Siegel, RL, Ward, EM, Jemal, A: Global cancer incidence and mortality rates and trends: an update. Cancer Epidemiol Biomarkers Prev 2016, 25:1627.CrossRefGoogle ScholarPubMed
Riihimaki, M, Hemminki, A, Fallah, M, et al: Metastatic sites and survival in lung cancer. Lung Cancer 2014, 86:7884.CrossRefGoogle ScholarPubMed
Tatsumori, T, Tsuta, K, Masai, K, et al: p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2. Appl Immunohistochem Mol Morphol 2014, 22:377–82.Google ScholarPubMed
Whithaus, K, Fukuoka, J, Prihoda, TJ, Jagirdar, J: Evaluation of napsin A, cytokeratin 5/6, p63, and thyroid transcription factor 1 in adenocarcinoma versus squamous cell carcinoma of the lung. Arch Pathol Lab Med 2012, 136:155–62.CrossRefGoogle ScholarPubMed
Ye, J, Findeis-Hosey, JJ, Yang, Q, et al: Combination of napsin A and TTF-1 immunohistochemistry helps in differentiating primary lung adenocarcinoma from metastatic carcinoma in the lung. Appl Immunohistochem Mol Morphol 2011, 19:313–17.CrossRefGoogle ScholarPubMed
Park, SY, Kim, BH, Kim, JH, Lee, S, Kang, GH: Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch Pathol Lab Med 2007, 131:1561–7.Google ScholarPubMed
Borasio, P, Berruti, A, Bille, A, et al: Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients. Eur J Cardiothorac Surg 2008, 33:307–13.CrossRefGoogle Scholar
Berg, KB, Dacic, S, Miller, C, Cheung, S, Churg, A: Utility of methylthioadenosine phosphorylase compared with BAP1 immunohistochemistry, and CDKN2A and NF2 fluorescence in situ hybridization in separating reactive mesothelial proliferations from epithelioid malignant mesotheliomas. Arch Pathol Lab Med 2018, 142:1549–53.CrossRefGoogle ScholarPubMed
Cigognetti, M, Lonardi, S, Fisogni, S, et al: BAP1 (BRCA1-associated protein 1) is a highly specific marker for differentiating mesothelioma from reactive mesothelial proliferations. Mod Pathol 2015, 28:1043–57.CrossRefGoogle ScholarPubMed
Pillappa, R, Maleszewski, JJ, Sukov, WR, et al: Loss of BAP1 expression in atypical mesothelial proliferations helps to predict malignant mesothelioma. Am J Surg Pathol 2018, 42:256–63.CrossRefGoogle ScholarPubMed
Ordonez, NG: The diagnostic utility of immunohistochemistry in distinguishing between epithelioid mesotheliomas and squamous carcinomas of the lung: a comparative study. Mod Pathol 2006, 19:417–28.Google ScholarPubMed
Ordonez, NG: The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma. Am J Surg Pathol 2003, 27:1031–51.CrossRefGoogle ScholarPubMed
Poor, H: Pulmonary vascular diseases in the elderly. Clin Geriatr Med 2017, 33:553–62.CrossRefGoogle ScholarPubMed
Reeves, JT, Linehan, JH, Stenmark, KR: Distensibility of the normal human lung circulation during exercise. Am J Physiol Lung Cell Mol Physiol 2005, 288:L419–25.CrossRefGoogle ScholarPubMed
Aguilaniu, B, Maitre, J, Glenet, S, Gegout-Petit, A, Guenard, H: European reference equations for CO and NO lung transfer. Eur Respir J 2008, 31:1091–7.CrossRefGoogle ScholarPubMed
Simonneau, G, Gatzoulis, MA, Adatia, I, et al: Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013, 62:D3441.CrossRefGoogle ScholarPubMed
Hoeper, MM, Huscher, D, Ghofrani, HA, et al: Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry. Int J Cardiol 2013, 168:871–80.CrossRefGoogle ScholarPubMed
Redfield, MM, Jacobsen, SJ, Burnett, JC, Jr., et al: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194202.CrossRefGoogle ScholarPubMed
Pugh, ME, Sivarajan, L, Wang, L, et al: Causes of pulmonary hypertension in the elderly. Chest 2014, 146:159–66.CrossRefGoogle ScholarPubMed
Foale, R, Nihoyannopoulos, P, McKenna, W, et al: Echocardiographic measurement of the normal adult right ventricle. Br Heart J 1986, 56:3344.CrossRefGoogle ScholarPubMed
Suzuki, J, Sakamoto, T, Takenaka, K, et al: Assessment of the thickness of the right ventricular free wall by magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Br Heart J 1988, 60:440–5.CrossRefGoogle ScholarPubMed
Vonk Noordegraaf, A, Galie, N: The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 2011, 20:243–53.CrossRefGoogle ScholarPubMed
Roden, AC, Camus, P: Iatrogenic pulmonary lesions. Semin Diagn Pathol 2018, 35:260–71.CrossRefGoogle ScholarPubMed
Tanawuttiwat, T, Harindhanavudhi, T, Hanif, S, Sahloul, MZ: Amiodarone-induced alveolar haemorrhage: a rare complication of a common medication. Heart Lung Circ 2010, 19:435–7.CrossRefGoogle ScholarPubMed
Iskandar, SB, Abi-Saleh, B, Keith, RL, Byrd, RP Jr, Roy, TM: Amiodarone-induced alveolar hemorrhage. South Med J 2006, 99:383–7.CrossRefGoogle ScholarPubMed
Larsen, BT, Vaszar, LT, Colby, TV, Tazelaar, HD: Lymphoid hyperplasia and eosinophilic pneumonia as histologic manifestations of amiodarone-induced lung toxicity. Am J Surg Pathol 2012, 36:509–16.CrossRefGoogle ScholarPubMed
Bone, RC, Wolfe, J, Sobonya, RE, et al: Desquamative interstitial pneumonia following chronic nitrofurantoin therapy. Chest 1976, 69:296–7.CrossRefGoogle ScholarPubMed
Yousem, SA, Lohr, RH, Colby, TV: Idiopathic bronchiolitis obliterans organizing pneumonia/cryptogenic organizing pneumonia with unfavorable outcome: pathologic predictors. Mod Pathol 1997, 10:864–71.Google ScholarPubMed
Sigdel, S, Gemind, JT, Tomashefski, JF, Jr.: The Movat pentachrome stain as a means of identifying microcrystalline cellulose among other particulates found in lung tissue. Arch Pathol Lab Med 2011, 135:249–54.Google ScholarPubMed
Haugen, RK: The Café coronary. Sudden deaths in restaurants. JAMA 1963, 186:142–3.CrossRefGoogle ScholarPubMed
Wick, R, Gilbert, JD, Byard, RW: Cafe coronary syndrome – fatal choking on food: an autopsy approach. J Clin Forensic Med 2006, 13:135–8.CrossRefGoogle Scholar

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