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Lung function trajectories in health and disease

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Summary

The normal lung function trajectory from birth to death has three phases: a growth phase (from birth to early adulthood), a plateau phase (that lasts for a few years), and a decline phase resulting from physiological lung ageing. Numerous genetic and environmental factors can alter one or more of these phases. Evidence shows that several lung function trajectories exist throughout the life course and, importantly, that some of them are associated with substantial implications for health and disease. Here, we review the evidence, formulate a series of questions, and identify various challenges that need to be addressed to identify potential opportunities to promote respiratory health.

Introduction

The normal lung function trajectory from birth to death has three phases (figure 1).1 First is a growth phase in which lung function increases as lungs mature and grow, particularly during puberty.2 The starting lung function at birth can vary depending on several conditions during pregnancy that might limit fetal lung development. This growth phase reaches a peak at age 20–25 years, and is earlier in women than in men.3 Second is a plateau phase that lasts for a few years, followed by a decline phase due to physiological lung ageing.3 Numerous genetic and environmental factors can alter one or more of these phases,4 resulting in a range of lung function trajectories (figure 1) that could have important clinical consequences. We review evidence supporting this statement and identify unanswered questions, challenges, and potential opportunities for intervention.

Section snippets

Abnormal lung growth

Genetic abnormalities, maternal tobacco smoking, maternal undernutrition, intrauterine growth restriction, preterm birth (<37 weeks of gestation), bronchopulmonary dysplasia, air pollution exposure, lower respiratory tract infections (particularly with respiratory syncytial virus), and active smoking during adolescence can alter lung growth in utero and after birth.4 Childhood asthma is often considered a risk factor for low lung function in early adulthood.5, 6 However, the diagnosis of asthma

Enhanced lung function decline

Traditionally, chronic obstructive pulmonary disease (COPD) has been considered a self-inflicted disease14 caused by smoking and characterised by accelerated lung function decline with age due to the abnormal inflammatory response elicited in so-called susceptible smokers.15 This notion is likely incomplete. First, about 30% of patients with COPD worldwide have never smoked.16 Second, exposure to other inhaled particles and gases than those of smoking (eg, biomass) can also lead to COPD in

Questions, opportunities, and challenges

Evidence shows that a range of lung function trajectories are indeed present in health and disease, and that they could have important clinical consequences. This knowledge raises several questions and challenges, but also opens new opportunities for prevention and early intervention.23 However, two potential caveats need to be considered. On the one hand, lung function is often used as a homogeneous term; yet, because of prenatal influences on later lung function and the well known programmed

Conclusions

There is now convincing evidence that a range of lung function trajectories are present throughout the life course and that some of them have substantial implications for health and disease. Yet, more research is necessary to identify patients who are on abnormal lung function growth trajectories as early as possible. It is unclear if any intervention can correct abnormal lung function growth trajectories in childhood, nor at what age these would need to be implemented to be most effective, but

Search strategy and selection criteria

We mostly based this Personal View on our experience and judgment, supported by selected references. We searched PubMed for articles published from Jan 1, 2017, to Oct 14, 2018, with the terms “lung function trajectories”, “early-life origins”, “COPD”, “asthma”, and “lung ageing”. We selected original research articles that included more than 100 participants, addressed the subject of lung function trajectories in early life (or during the life span), and were related to airway disease.

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