Reduced lung elastic recoil, FEV1 and post-operative atelectasis in ageing
Ageing reduces elastic recoil (springiness): small airways close early, lowering FEV1 (volume blown out in the first second of a forced breath) and raising post-operative atelectasis (partial lung collapse) risk.
Remember
Less elastic recoil leaves the small airways and alveoli with less support, so FEV1 falls with age and atelectasis is a common complication after surgery in older people.
With age the lungs have less elastic recoil, the springiness that pulls the lung back to a smaller size after stretching and helps keep the small airways open. The supporting tissue around the peripheral airways (the small air tubes at the edge of the lung) is also lost, so these airways are less well supported.
When an older adult breathes out forcefully, the small airways close early and narrow, which limits how quickly air leaves, so the FEV1 falls. The FVC (forced vital capacity, the total volume blown out) and the vital capacity (the largest volume that can be moved in one breath) fall as well, and the chest wall stiffens.
The same loss of support affects the alveoli (the tiny air sacs where gas is exchanged) and the terminal branches of the airways (the smallest air tubes), which are more susceptible to collapsing. After an operation, especially abdominal surgery, breathing can be shallow because of pain and drugs, and the bases of the lungs are then not fully inflated. Collapsed areas then form, which is atelectasis (partial lung collapse).
The loss of elastic recoil happens even without smoking or lung disease, because it is part of normal ageing and not the result of illness. Collapse can lead to hypoxia (low blood oxygen) and pneumonia, which are increasingly common after surgery in older people, so older people need deep breathing and good pain relief.
Key facts
- Elastic recoil
- falls with age, so the alveoli and small airways have less support.
- FEV1
- falls with age because the small airways close early on forced expiration.
- Other measures
- FVC and vital capacity also fall, and these are normal ageing changes.
- Chest wall
- also stiffens with age.
- Normal ageing
- recoil falls even without smoking or lung disease.
- Consequences
- hypoxia and pneumonia if collapse persists.
Exam traps
- A slower passage of oxygen across the alveolar-capillary membrane (the wall between air and blood) limits oxygen uptake, but it does not explain collapse of the alveoli, which follows the loss of elastic support.
- Calcified bronchial cartilage (hardened cartilage) can occur with age, yet the central airways stay open. A falling FEV1 reflects small airways that lose elastic support and close early.
- Residual volume (the volume left in the lungs after breathing out) does rise with age, but the trapped air follows early airway closure and does not itself make alveoli collapse.
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