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The normal lung development in early childhood is crucial in preventing Chronic Obstructive Pulmonary Disease

A study published in the New England Journal of Medicine (NEJM) shows that abnormal lung development before 40 years of age predisposes to a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) 20 years later. Traditionally it was considered that COPD was a self-inflicted disease by smoking. This study shows that this is true in about half the cases but in the other half, abnormal lung development in the early years of life (and probably during pregnancy) is a very important risk factor. Dr. Àlvar Agustí, head of the Institute Clínic of Thorax at Hospital Clínic and of the IDIBAPS team  Inflammation and repair in respiratory illnesses, member of the Networked Biomedical Research Center for Respiratory Diseases (CIBERES) and founding president of the Barcelona Respiratory Network (BRN), is one of three co-directors of the study.

COPD is a disease that affects 10% of the general population and is the third leading cause of death worldwide. It is characterized by a limitation of expiratory air flow and is associated with an abnormal inflammatory response in the airways. Until now, it was considered that the main cause for the disease is tobacco. From now on, there should be also considered lung development factors in childhood and early adulthood.

The research published in the NEJM was conducted with data from three independent studies that followed 25,000 people whose respiratory conditions were assessed over 30 years with repeated measures of lung function. Researchers have now classified the participants in these studies based on their lung capacity at the time of cohort interception (before 40 years of age), measured as the maximum expiratory volume in one second (FEV1), or the amount of air that a person can exhale quickly, and the presence or absence of COPD at the last study visit. Then the rate of decline in FEV1 over time was determined.

Among those who at baseline had a good lung function with a FEV1 equal to or greater than 80% of the predicted value, only 7% had COPD after 22 years of observation. In contrast, 26% of participants with impaired lung function before 40 years of age -FEV1 below 80% of the expected value- had COPD at the end of follow-up. Thus, these results demonstrate that an impaired lung capacity before 40 years of age is a condition that predisposes to the later development of COPD and that the maximum level of lung function achieved before adulthood is a key determinant of future COPD risk.

For decades it was thought that the disease was caused by a rapid and unexplained decline in pulmonary function. This study contradicts this statement to demonstrate that a rapid rate of decline in FEV1 over time does not indicate, necessarily, the onset of the disease: among the people with COPD at the end of the follow-up, only 50% had an accelerated decline in FEV1.

"This study shows that the best tool for preventing the onset of COPD in adulthood is to achieve a normal lung development during adolescence and never smoking," says Dr. Àlvar Agustí, one of the co-directors study. "Not to smoke and avoid passive exposure to inhaled particles such as those from tobacco or pollution are good strategies to reach a maximum lung capacity" he adds.

This work will help to better understand COPD and its treatment and, especially, it can play a key role in preventing the emergence of new cases from the identification of young people at high risk.

Article reference:

Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease.

Lange P, Celli B, Agustí A, BojeJensen G, Divo M, Faner R, Guerra S, Marott JL, Martinez FD, Martinez-Camblor P, Meek P, Owen CA, Petersen H, Pinto-Plata V, Schnohr P, Sood A, Soriano JB, Tesfaigzi Y, Vestbo J.

N Engl J Med. 2015 Jul 9;373(2):111-22. doi: 10.1056/NEJMoa1411532.