[Respiratory medicine in geriatrics. A cultural niche of relevant theoretical and practical importance]

Respiratory medicine in the elderly represents a topic of increasing interest in the developed countries, because of its peculiar clinical and therapeutical implications. In this respect, a deeper knowledge of the biology and physiology of aging lung is desirable: namely, the age-related immunological and structural changes involving the respiratory system do influence clinical presentation and response to the treatment in older people. A better understanding of the pharmacology in the elderly which is recognized to be different for several aspects from that of the general population, is mandatory in order to better approach these practical problems. This short review emphasizes the need of the "longitudinal", rather than "transversal", epidemiological surveys which are uniquely able to give useful information on the natural history, even in older populations. In addition, clinical and therapeutical peculiarities of some respiratory illnesses such as infectious lung diseases, including pulmonary tuberculosis, COLD and bronchial asthma, sleep-related respiratory disorders will be underlined. Finally, a few problems concerning the management of the geriatric subject with chronic respiratory disease will be analyzed, focusing mainly on the difficulties inherent in the inhalant therapy and functional evaluation of this kind of patients.