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The Role of Lung Function in Determining Which Children Develop Asthma
Cindy T McEvoy1, Peter N Le Souef2, Fernando D Martinez3
1Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health & Science University, Portland, Ore.
Insights
Early airway function assessed in infancy predicts later asthma risk. Factors like prematurity, smoke exposure, and genetics influence this risk, highlighting the need for early interventions and lifelong monitoring for asthma prevention.
Area of Science:
- Respiratory Medicine
- Pediatric Pulmonology
- Epidemiology
Background:
- Altered early airway function is a significant risk factor for developing wheezing illnesses and asthma later in life.
- Early life factors such as prematurity and smoke exposure can directly impact airway function and long-term asthma risk.
- Immune responses, viral infections, microbiome, genetics, and epigenetics can indirectly influence early airway function and asthma susceptibility.
Purpose of the Study:
- To investigate the role of early airway function in predicting adult asthma risk.
- To identify pre- and postnatal factors influencing early airway function and subsequent asthma development.
- To explore potential interventions for mitigating asthma risk through early life management.
Main Methods:
- Longitudinal studies assessing airway function in infancy.
- Analysis of pre- and postnatal factors impacting airway development.
- Monitoring of wheezing illnesses and asthma development through adulthood.
Main Results:
- Early airway function indices predict adult airway size, wall thickness, and asthma risk.
- Factors like extreme prematurity and cigarette smoke exposure are linked to persistent alterations in airway function.
- Vitamin C supplementation in pregnant smokers showed potential to mitigate in utero smoke effects on offspring lung function.
Conclusions:
- Airway size and factors influencing it are critical determinants of lifetime asthma risk.
- Effective asthma prevention strategies require interventions targeting early life airway development.
- Further research in well-phenotyped birth cohorts with long-term monitoring is essential for advancing asthma prevention.
Abstract:
Longitudinal studies have demonstrated that altered indices of airway function, assessed shortly after birth, are a risk factor for the subsequent development of wheezing illnesses and asthma, and that these indices predict airway size and airway wall thickness in adult life. Pre- and postnatal factors that directly alter early airway function, such as extreme prematurity and cigarette smoke, may continue to affect airway function and, hence, the risks for wheeze and asthma. Early airway function and an associated asthma risk may also be indirectly influenced by immune system responses, respiratory viruses, the airway microbiome, genetics, and epigenetics, especially if they affect airway epithelial dysfunction. Few if any interventions, apart from smoking avoidance, have been proven to alter the risks of developing asthma, but vitamin C supplementation to pregnant smokers may help decrease the effects of in utero smoke on offspring lung function. We conclude that airway size and the factors influencing this play an important role in determining the risk for asthma across the lifetime. Progress in asthma prevention is long overdue and this may benefit from carefully designed interventions in well-phenotyped longitudinal birth cohorts with early airway function assessments monitored through to adulthood.
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