Chest
Volume 160, Issue 3, September 2021, Pages 879-889
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COPD: CHEST Reviews
Impaired Respiratory Health and Life Course Transitions From Health to Chronic Lung Disease

https://doi.org/10.1016/j.chest.2021.04.009Get rights and content

Primary prevention and interception of chronic lung disease are essential in the effort to reduce the morbidity and mortality caused by respiratory conditions. In this review, we apply a life course approach that examines exposures across the life span to identify risk factors that are associated with not only chronic lung disease but also an intermediate phenotype between ideal lung health and lung disease, termed “impaired respiratory health.” Notably, risk factors such as exposure to tobacco smoke and air pollution, as well as obesity and physical fitness, affect respiratory health across the life course by being associated with both abnormal lung growth and lung function decline. We then discuss the importance of disease interception and identifying those at highest risk of developing chronic lung disease. This work begins with understanding and detecting impaired respiratory health, and we review several promising molecular biomarkers, predictive symptoms, and early imaging findings that may lead to a better understanding of this intermediate phenotype.

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.

References (114)

  • B. Lapin et al.

    Relationship between prenatal antibiotic use and asthma in at-risk children

    Ann Allergy Asthma Immunol

    (2015)
  • D.C.M. Belgrave et al.

    Lung function trajectories from pre-school age to adulthood and their associations with early life factors: a retrospective analysis of three population-based birth cohort studies

    Lancet Respir Med

    (2018)
  • M.R. Sears et al.

    Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study

    Lancet

    (2002)
  • E.C. Oelsner et al.

    Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study

    Lancet Respir Med

    (2020)
  • D.N. Bhatta et al.

    Association of e-cigarette use with respiratory disease among adults: a longitudinal analysis

    Am J Prev Med

    (2020)
  • L.F.F. da Silva et al.

    Impaired lung function in individuals chronically exposed to biomass combustion

    Environ Res

    (2012)
  • U. Peters et al.

    Beyond BMI: obesity and lung disease

    Chest

    (2018)
  • C.T. McEvoy et al.

    Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function (VCSIP): rationale, design, and methods of a randomized, controlled trial of vitamin C supplementation in pregnancy for the primary prevention of effects of in utero tobacco smoke exposure on infant lung function and respiratory health

    Contemp Clin Trials

    (2017)
  • B. Thyagarajan et al.

    Association of circulating adhesion molecules with lung function: the CARDIA study

    Chest

    (2009)
  • T.E. King et al.

    Idiopathic pulmonary fibrosis

    Lancet

    (2011)
  • G.A. Mensah et al.

    Decline in cardiovascular mortality

    Circ Res

    (2017)
  • C.A. Camargo et al.

    Promotion of lung health: NHLBI workshop on the primary prevention of chronic lung diseases

    Ann Am Thorac Soc

    (2014)
  • Y. Ben-Shlomo et al.

    A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives

    Int J Epidemiol

    (2002)
  • D.J. Barker et al.

    Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease

    BMJ

    (1991)
  • P.A. Reyfman et al.

    Defining impaired respiratory health: a paradigm shift for pulmonary medicine

    Am J Respir Crit Care Med

    (2018)
  • C. Fletcher et al.

    The natural history of chronic airflow obstruction

    BMJ

    (1977)
  • P. Lange et al.

    Lung-function trajectories leading to chronic obstructive pulmonary disease

    N Engl J Med

    (2015)
  • B. Burrows et al.

    The relationship of childhood respiratory illness to adult obstructive airway disease

    Am Rev Respir Dis

    (1977)
  • D.J. Hole et al.

    Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study

    BMJ

    (1996)
  • D.M. Mannino et al.

    Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study

    Thorax

    (2003)
  • Y. Çolak et al.

    Relationship between supernormal lung function and long-term risk of hospitalisations and mortality: a population-based cohort study

    Eur Respir J

    (2021)
  • M.M. Vasquez et al.

    Low lung function in young adult life is associated with early mortality

    Am J Respir Crit Care Med

    (2017)
  • R.P. Akkermans et al.

    COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers

    Eur Respir J

    (2014)
  • I. Cerveri et al.

    Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes

    Thorax

    (2008)
  • C. Pothirat et al.

    Misidentification of airflow obstruction: prevalence and clinical significance in an epidemiological study

    Int J Chron Obstruct Pulmon Dis

    (2015)
  • Y. Çolak et al.

    Young and middle-aged adults with airflow limitation according to lower limit of normal but not fixed ratio have high morbidity and poor survival: a population-based prospective cohort study

    Eur Respir J

    (2018)
  • F.J. Martinez et al.

    At the root: defining and halting progression of early chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (2018)
  • Y. Çolak et al.

    Importance of early COPD in young adults for development of clinical COPD: findings from the Copenhagen General Population Study [published online ahead of print November 3, 2020]. Am J Respir Crit Care Med

  • Y. Çolak et al.

    Prevalence, characteristics, and prognosis of early chronic obstructive pulmonary disease: the Copenhagen General Population Study

    Am J Respir Crit Care Med

    (2019)
  • H. Bisgaard et al.

    Interaction between asthma and lung function growth in early life

    Am J Respir Crit Care Med

    (2012)
  • C.E. Berry et al.

    A distinct low lung function trajectory from childhood to the fourth decade of life

    Am J Respir Crit Care Med

    (2016)
  • H. Burke et al.

    Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis

    Pediatrics

    (2012)
  • H. Moshammer et al.

    Parental smoking and lung function in children

    Am J Respir Crit Care Med

    (2006)
  • H.S. Sekhon et al.

    Prenatal nicotine exposure alters pulmonary function in newborn rhesus monkeys

    Am J Respir Crit Care Med

    (2001)
  • E.R. Spindel et al.

    The role of nicotine in the effects of maternal smoking during pregnancy on lung development and childhood respiratory disease: implications for dangers of e-cigarettes

    Am J Respir Crit Care Med

    (2016)
  • C. Wongtrakool et al.

    Prenatal nicotine exposure alters lung function and airway geometry through α7 nicotinic receptors

    Am J Respir Cell Mol Biol

    (2012)
  • H. Chen et al.

    Maternal e-cigarette exposure in mice alters DNA methylation and lung cytokine expression in offspring

    Am J Respir Cell Mol Biol

    (2017)
  • N.N. Dhalwani et al.

    Nicotine replacement therapy in pregnancy and major congenital anomalies in offspring

    Pediatrics

    (2015)
  • C.A. Edwards et al.

    Relationship between birth weight and adult lung function: controlling for maternal factors

    Thorax

    (2003)
  • R.J. Hancox et al.

    Associations between birth weight, early childhood weight gain and adult lung function

    Thorax

    (2009)
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