Chest
COPD: CHEST ReviewsImpaired Respiratory Health and Life Course Transitions From Health to Chronic Lung Disease
Section snippets
Impaired Respiratory Health: An Intermediate Phenotype Between Health and Disease
In 1977, Burrows and colleagues9 fundamentally influenced our understanding of the development of COPD by showing that childhood respiratory disorders are associated with both decreased peak lung function and excessive decline in lung function later in life. These findings helped promote a model of varied lung function trajectories of growth and decline over the life course.7,8 Following lung function trajectories over time allows for the identification of populations with ideal respiratory
Prenatal Exposures and Association With Lung Growth
It is now well established that early life events, including those occurring during gestation, may increase the risk of COPD developing.4,26,27 Decreased lung function and increased bronchial hyperresponsiveness in neonates has been associated with increased risk of developing asthma at age 7 years.28 Low lung function in infancy has also been shown in multiple studies to be associated with reduced lung function in childhood and young adulthood.29,30 Berry and colleagues30 found that infants in
Early Life Exposures and Association With Lung Growth
Childhood exposures to both tobacco smoke and air pollution have been associated with increased rates of asthma and lower lung function in childhood.31,48, 49, 50, 51, 52 In a prospective study of children in southern California, those living in communities with the highest levels of air pollution had a nearly 5 times greater risk of having an FEV1 < 80% predicted at age 18 years compared with those living in communities with the lowest air pollution.49 Additionally, exposure to air pollution
Later Life Exposures and Association With Lung Function Decline
Smoking tobacco products is a well-established risk factor for chronic lung diseases and is also highly associated with increased lung function decline. Heavy stable smokers compared with never smokers have nearly 8 times the odds of obstructive lung physiology and 20 times the odds of emphysema as measured with CT scanning after 25 years of follow-up.69 Even those with low-intensity sustained smoking show up to a 5 times greater rate of FEV1 decline and higher odds of having emphysema on CT
Advancing the Agenda for Disease Interception
There remain gaps in knowledge surrounding the effect of certain exposures on respiratory health (Fig 2). Some notable areas for future and ongoing research are the effect of diet and nutrition, as well as e-cigarette use, on lung development and lung function decline. Nonetheless, the identification of risk factors has had a notable effect on the primary prevention of lung disease. Although primary prevention is vital to reduce the burden of lung disease, disease interception is another
Conclusions
Primary prevention and interception of lung disease is an achievable goal with use of a life course approach to understand better ideal respiratory health and the exposures that can lead to impaired respiratory health and chronic lung disease. Considerable achievements have been made in the discovery of prenatal, childhood, and later life risk factors for impaired respiratory health and lung disease. However, additional life course studies dedicated to respiratory health are needed to
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: R. K. reports personal fees from Aptus Health, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Boston Consulting Group, personal fees from Boston Scientific, personal fees from CVS Caremark, grants and personal fees from GlaxoSmithKline, grants from PneumRx (BTG), and grants from Spiration, all outside the submitted work. None declared (G. Y.
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