Lifetime lung function trajectories and COPD: when the train derails

Abstract

Increasing recognition that chronic respiratory disease originates in early life has shifted the paradigm away from traditional concepts of chronic obstructive pulmonary disease (COPD) as solely a smoker's disease. 1 Martinez FD Early-life origins of chronic obstructive pulmonary disease. N Engl J Med. 2016; 375: 871-878 Crossref PubMed Scopus (277) Google Scholar Building on Fletcher and Peto's landmark publication highlighting smoking-related decline of FEV1, 2 Fletcher C Peto R The natural history of chronic airflow obstruction. BMJ. 1977; 1: 1645-1648 Crossref PubMed Scopus (1800) Google Scholar multiple cohort studies have since implicated altered lung function trajectories originating in childhood in the accelerated development of lung disease. 3 Berry CE Billheimer D Jenkins IC et al. A distinct low lung function trajectory from childhood to the fourth decade of life. Am J Respir Crit Care Med. 2016; 194: 607-612 Crossref PubMed Scopus (114) Google Scholar , 4 Lange P Celli B Agustí A et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med. 2015; 373: 111-122 Crossref PubMed Scopus (346) Google Scholar , 5 McGeachie MJ Yates KP Zhou X et al. Patterns of growth and decline in lung function in persistent childhood asthma. N Engl J Med. 2016; 374: 1842-1852 Crossref PubMed Scopus (350) Google Scholar , 6 Stern DA Morgan WJ Wright AL Guerra S Martinez FD Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet. 2007; 370: 758-764 Summary Full Text Full Text PDF PubMed Scopus (429) Google Scholar This work has revealed that many individuals tend to track along a lung function percentile established in childhood, such that those who begin life at a lower lung function percentile because of adverse perinatal or chronic childhood respiratory conditions are hindered from reaching maximal peak lung function as young adults. Even with the normal age-related rate of lung function decline, these individuals stay on a path with an increased lifetime risk for COPD. Importantly, multiple identified early-life risk factors—including those experienced in utero—alter developmental programming, affecting the timing and course of progression to chronic lung disease. 7 Postma DS Bush A van den Berge M Risk factors and early origins of chronic obstructive pulmonary disease. Lancet. 2015; 385: 899-909 Summary Full Text Full Text PDF PubMed Scopus (318) Google Scholar Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort studyTo our knowledge, this is the first study to characterise lifetime phenotypes of obstruction and restriction simultaneously using objective data-driven techniques and unique life course spirometry measures of FEV1/FVC ratio and FVC from childhood to middle age. Mixed and obstructive-only patterns indicate those who might benefit from early COPD interventions. Those with the restrictive-only pattern had evidence of true lung restriction and were at increased risk of multimorbidity by middle age. Full-Text PDF