Treatment for COPD may need to start before birth

Poor airway function shortly after birth should be recognised as a risk factor for airflow obstruction in young adults, and prevention of chronic obstructive pulmonary disease (COPD) may need to start in fetal life. These are the conclusions of authors of an Article in this week’s edition of The Lancet.

Professor Fernando Martinez, Arizona Respiratory Centre, University of Arizona Health Sciences Center, Tucson, Arizona, USA and colleagues did a study of 169 infants enrolled at birth in the Tucson Children’s Respiratory Study between 1980 and 1984, each of which has their maximum expiratory air flows measured using the chest compression technique at an average age of 2.3 months. Of these, 123 then had their lung function measured at least once at ages 11, 16, and 22 years. The measurements used were of forced expiratory volume in one second (FEV1)*, forced vital capacity (FVC)*, and forced expiratory flow between 25% and 75% of FVC (FEF25-75)*, both before and after treatment with a bronchodilator (180 µg albuterol).

The researchers found that participants who were in the lowest quartile for maximum expiratory flows as infants also had lower values for FEV1,FVC, and FEF25-75 up to age 22, after adjustment for height, weight, age, and sex, as compared with those in the upper three quartiles combined. These differences did not change after additional adjustment for wheeze, smoking, atopy or parental asthma.

The authors conclude that individuals born with poorer lung function continue this trend up to 22 years of age, and that further research is needed into how the lungs develop in the fetus. The authors say this is “a process that could be impaired in utero by both genetic and environmental factors. Among these factors, maternal smoking during pregnancy has been consistently associated with poor lung function in both infants and older children.”

They add: “Our results suggest that a better understanding of the mechanisms that control normal lung growth in utero would contribute to development of strategies for the prevention of COPD in adult life.”

In an accompanying Comment, Professor Michael Silverman, University of Leicester, UK, and Dr Claudia Kuehni, University of Bern, Switzerland, say: “As COPD is set globally to become the third most important cause of death, now is the time to add research into its earliest origins to the agenda.”

Notes to editors: FEV1 is the amount of air that you can forcibly blow out in one second, measured in litres. Along with FVC it is considered one of the primary indicators of lung function; FVC is the total amount of air that you can forcibly blow out after full inspiration, measured in litres; FEF25-75 is the average flow (or speed) of air coming out of the lung during the middle portion of the expiration (also sometimes referred to as the MMEF, for maximal mid-expiratory flow).