Elderly patients present challenges in diagnosis and treatment of various disease processes. Although they may develop thoracic diseases seen in other age groups, older patients often have atypical presentations of these diseases, and may be vulnerable to thoracic pathology as a result of comorbid diseases. Pulmonary function testing of the elderly population shows increased ventilation-perfusion mismatch, decreased forced expiratory volumes, and decreased diffusion capacities. Combined with increased chest wall rigidity, decreasing muscle mass, impaired mucociliary clearance, blunted perception of dyspnea, and possible increased aspiration risk because of underlying neurologic dysfunction, these physiologic changes associated with aging make this population particularly vulnerable to thoracic disease.