In developed countries, the gradual ageing of the population became one of the most significant socioeconomic factors of the twentieth century, as older patients are often malnourished and immunocompromised. Improved living conditions and advances in medical science have increased life expectancy extended by several decades. As people age, they experience various physiological and functional changes, often leading to atrophy and decreased efficiency in several organs and systems, including the respiratory system. The development of the airways and lung parenchyma begins during morphogenesis in utero and continues up to the age of 30 years, after which, a number of processes begin to determine the progressive ageing of the lungs and, in particular, a reduction in mucociliary clearance, a decrease in alveolar surface area, with degradation of elastin and collagen, which is associated with dilatation of the air spaces. The elderly population (>65 years of age) is at greater risk of developing tracheobronchial and lower respiratory tract diseases, due both to long-term exposure to ever-worsening air pollution, smoking, and occupational toxins, and to their fragility and comorbidity; they also have reduced exercise capacity, lower lung oxygenation, and a greater susceptibility to recurrent lung infections and chronic obstructive pulmonary disease (COPD) (Rojas et al. 2015; Brandsma et al. 2017; Bowdish 2019). Airway disease in the elderly can be divided into upper and lower airway disease. A predominant feature of lower airway disease is the involvement of the bronchioles; sometimes this may be associated with the involvement of the more proximal airways or even spread distally to the lung parenchyma (Table 1). The most common lower airway diseases in elderly patients are COPD, asthma, and bronchiectasis. Upper airway diseases, on the other hand, are a heterogeneous group of disorders and are often undiagnosed, usually because they are asymptomatic or paucisymptomatic, and therefore generally untreated. The most common upper airway disorders in older patients are tracheobronchomegaly, tracheobronchial diverticula, tracheobronchomalacia, tracheobronchopathia osteochondroplasia, Wegener’s granulomatosis, and amyloidosis (Table 2). In this chapter, we will look at the main causes of airway pathology in the elderly (Maggi et al. 2006).