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Interstitial Lung Disease in the Elderly: A Review of Pathogenesis and Clinical Management

Patterson, Karen C., MD*,†

doi: 10.1097/CPM.0000000000000270
Interstitial, Inflammatory & Occupational Lung Disease

As the human lifespan continues to rise, the number of elderly patients with interstitial lung disease (ILD) has never been higher. Idiopathic pulmonary fibrosis is the most common ILD among older patients, but ILD related to autoimmune disease and hypersensitivity pneumonitis are also important diseases in this age group. Usual interstitial pneumonia is the histopathologic pattern of IPF; mitochondrial dysfunction, oxidative stress from telomere damage, and endoplasmic reticular stress from the unfolded protein response are the aging processes implicated in alveolar epithelial cell injury and downstream aberrant fibroblast activity. Driven by a variety of connective tissue and musculoskeletal changes, pulmonary fitness declines with aging, which is reflected in lower measures of spirometry and diffusion capacity. Frailty and increased susceptibility to infection compound these effects. For these reasons, along with polypharmacy concerns, old age can complicate the management of ILD. That said, most older patients tolerate treatment, and advanced age (above 80 y) alone is not a contraindication for immunosuppressive or antifibrotic therapies. In addition, lung transplantation can be beneficial in carefully selected older patients. Finally, it is not clear whether subclinical interstitial abnormalities, observed on chest imaging in a sizeable number of older patients, represent an early phase of ILD. While currently available data are reassuring, more research is needed to better understand outcomes for these patients.

*Brighton and Sussex Medical School, Brighton, England

Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Pennsylvania, PA

Disclosure: The author declares that there is no conflicts of interest.

Address correspondence to: Karen C. Patterson, MD, BSMS, Teaching Building, University of Sussex, Falmer, BN1 9PX, UK. E-mail:

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