Childhood origins of COPD

Chronic obstructive pulmonary disease (COPD) is a common condition in adults, with high morbidity and mortality. COPD has been mainly attributed to active smoking in adulthood, but some patients are diagnosed with COPD in the absence of a smoking history and only 20–25% of smokers develop COPD. 1 Lokke A Lange P Scharling H Fabricius P Vestbo J Developing COPD: a 25 year follow up study of the general population. Thorax. 2006; 61: 935-939 Crossref PubMed Scopus (458) Google Scholar In recent years, the complexity of COPD has become apparent. In 15–45% of patients with COPD, features of asthma are present—the so-called asthma-COPD overlap syndrome. 2 Postma DS Rabe KF The asthma-COPD overlap syndrome. N Engl J Med. 2015; 373: 1241-1249 Crossref PubMed Scopus (406) Google Scholar Thus, COPD and asthma in adulthood might differ in their extremes. However, the clinical expression of COPD in an individual patient might depend not only on age, sex, and environmental factors such as nutrition, occupational hazards and smoking, but also on the genetic background. 2 Postma DS Rabe KF The asthma-COPD overlap syndrome. N Engl J Med. 2015; 373: 1241-1249 Crossref PubMed Scopus (406) Google Scholar More than 20 genetic loci have been associated with COPD. 3 Hobbs BD de Jong K Lamontagne M et al. Genetic loci associated with chronic obstructive pulmonary disease overlap with loci for lung function and pulmonary fibrosis. Nat Genet. 2017; 49: 426-432 Crossref PubMed Scopus (223) Google Scholar Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of lifeWe identified six potential FEV1 trajectories, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures whose impact was aggravated by adult factors. We postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking, especially in those with smoking parents or low childhood lung function, might minimise COPD risk. Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials. Full-Text PDF 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 studiesReduction of childhood smoke exposure and minimisation of the risk of early-life sensitisation and wheezing exacerbations might reduce the risk of diminished lung function in early adulthood. Full-Text PDF