ABSTRACT
Aging is associated with a progressive deterioration in the structure and function
of the pulmonary circulation. Remodeling of the pulmonary vasculature occurs from
maturity to senescence that is characterized by an increase in pulmonary vascular
stiffness, pulmonary vascular pressures, and pulmonary vascular resistance along with
increased heterogeneity of alveolar ventilation and pulmonary perfusion and decreased
pulmonary capillary blood volume and membrane diffusing capacity that is consistent
with a reduction in alveolar-capillary surface area. In theory, the aforementioned
age-related changes in the pulmonary circulation may conspire to make elderly individuals
more susceptible to gas exchange abnormalities during exercise. However, despite the
erosion in ventilatory reserve with aging, the healthy older adult appears able to
maintain alveolar ventilation at a level that allows maintenance of arterial blood
gases within normal limits, even during heavy exercise. This ability to maintain adequate
gas exchange likely occurs because age-related reductions in the maximal metabolic
demand of exercise occur at a rate equal to or greater than the rate of deterioration
in ventilatory reserve. A more prominent aspect of aging is the loss of lung elastic
recoil that is associated with a modest reduction in the expiratory boundary of the
maximal flow-volume envelope. This in turn increases the severity of expiratory airflow
limitation and induces dynamic lung hyperinflation during exercise. The consequences
of this age-associated decrease in elastic recoil on the pulmonary circulation are
speculative, but an age-associated decline in elastic recoil may influence pulmonary
vascular resistance and cardiac output, in addition to its impact on the work and
oxygen cost of breathing.
KEYWORDS
Aging - pulmonary circulation - gas exchange - exercise
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Bruce D JohnsonPh.D.
Division of Cardiovascular Diseases, Department of Internal Medicine, Gonda 5-369
200 First St. SW, Mayo Clinic, Rochester, MN 55905
eMail: johnson.bruce@mayo.edu
