Shaping Lung Health From the Start: Early-Life Trajectories and Lifelong Risk

Extract In their landmark study of the natural history of chronic airflow obstruction among London working men, F letcher and P eto [1] identified two factors leading to impaired lung function in later life. The first and most important was cigarette smoking causing an accelerated age-related decline in forced expiratory volume in 1 s (FEV 1 ).

However, they also demonstrated that starting with a low lung function in early adulthood enhanced the risk. Thus, someone who already has lung function at the lower end of the normal range in their mid-20s is likely to experience disability much earlier than someone who starts with above average lung function, despite a similar rate of lung function decline.

This second factor, having been largely ignored for many years, has been reaffirmed in more recent studies and is now highlighted in international guidelines [2, 3]. Attention has therefore turned to how we might maximise lung growth in childhood and adolescence.