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The early-life origins of asthma

Sejal Saglani1, Andrew Bush

  • 1Imperial School of Medicine at National Heart and Lung Institute, London, UK.

Current Opinion in Allergy and Clinical Immunology
|January 16, 2007
PubMed

Insights

The first three years of life are critical for lung function and wheeze prognosis. Gene-environment interactions during this period significantly influence long-term respiratory health.

Area of Science:

  • Pediatric Pulmonology
  • Developmental Immunology
  • Genetic Epidemiology

Background:

  • Early-life events profoundly impact adult lung function and disease susceptibility.
  • The prognosis of preschool wheeze is influenced by gene-environment interactions from conception through the first three years of life.

Purpose of the Study:

  • To review the critical role of early-life factors in determining lung function and wheeze prognosis.
  • To examine the impact of gene-environment interactions on respiratory health in early childhood.

Main Methods:

  • Analysis of birth cohort studies tracking lung function from infancy to adolescence.
  • Investigation of umbilical cord blood immunological responses to viral infections.
  • Evaluation of the role of allergic sensitization and specific immune cells (neutrophils) in preschool wheeze.

Main Results:

  • Lung function established in the first three years tracks into later life.
  • Antenatal factors influence infant immunological responses to viral infections.
  • Neutrophils, not eosinophils, are key in preschool wheeze; early allergic sensitization is crucial for prognosis.
  • Airway pathology develops post-symptom onset, with established atopic asthma by school age.
  • Isolated gene studies (e.g., ADAM33) without environmental context may yield misleading results.
  • Inhaled corticosteroids do not prevent progression from intermittent to persistent wheeze.

Conclusions:

  • The first three years of life are pivotal for lifelong lung function and wheeze prognosis.
  • Future research must integrate genetic and environmental factors within focused hypotheses to understand disease development and inform therapy.
Abstract

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