The Developmental Origins of Asthma and COPD

Approximately two-thirds of cases of chronic obstructive pulmonary disease (COPD) and adult asthma are in part driven by impaired lung development related to early-life events. Many children who suffer insults to their lungs during the first few years of life experience abnormal lung development, growth, and/or maturation, leading to impaired lung function, which may persist throughout their lifespan. This abnormal lung trajectory may be exacerbated by lung dysanapsis, genetic and epigenetic alterations, oxidative stress and/or inflammation in the airways related to environmental factors including exposure to active or secondhand smoke, air pollution, poor nutrition and social deprivation, and repeated childhood respiratory tract infections. Children with asthma may transition to COPD in adulthood if their asthma is poorly controlled or in the presence of other risk factors such as smoking. As many of these factors are modifiable, prompt diagnosis and implementation of preventive measures should be considered as early as possible in children at risk for abnormal lung development. This review provides an update on the interplay between genetic, environmental, and socioeconomic factors, their cumulative impact on lung development, and its implication for the risk and burden of asthma and COPD in the global population.