Lung development, lung growth and the future of respiratory medicine

Abstract

Most respiratory physicians will agree that the lung is a sexy organ and worthy of intense study. We understand its significance as an important biological system. Respiratory diseases are responsible for ∼50% of acute medical conditions in children and rank second to cardiovascular disease in causing morbidity and mortality at a cost of well in excess of €100 billion to the European Community 1. A major driver in research over the last two decades has been the unlocking of the so-called “silent period” in the preschool years where, until recently, there was a dearth of knowledge about early disease development, lung growth and physiology. As our knowledge increases, it is becoming apparent that these early years of life are extremely important, for it is the time during which many chronic respiratory diseases appear to have their origin. For example, persistent asthma arising from interactions between genetic predisposition and infection and allergy-induced airways inflammation results in airway remodelling that occurs during the first 3 yrs of life 2. Lung function in older children with asthma appears to “track” into adulthood, and studies are currently investigating the interaction between childhood asthma and the development of chronic obstructive pulmonary disease in later life 3. In cystic fibrosis, lung disease appears to start soon after birth, with pulmonary inflammation and infection leading to the development of structural 4 and functional changes 5 within the first few months of life. Lung function in those born prematurely but without chronic lung disease appears to be lower than term-born infants, and longitudinal studies suggest that “catch-up” in lung function does …