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.
Personal ViewLung function trajectories in health and disease
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
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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
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Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life
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