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Paediatric Pulmonology and Allergology
2006 April, Vol. IX, No. 1 (3077-3089)
COPD IN CHILDREN: PREVENTION, EARLY INTERVENTION
Andrew Bush
Professor of Paediatric Respirology, Imperial School of Medicine at National Heart and Lung Institute and Honorary Consultant Paediatric Chest Physician at Royal Brompton Hospital, London, UK
Chronic obstructive pulmonary disease (COPD) is conventionally thought of as a disease of adult smokers, related to airway inflammation and structural airway changes (remodelling). However, there is important epidemiological evidence, from a series of studies with overlapping age group from birth to late middle age, that early life events, including antenatal influences on lung growth, set the child up for future COPD. This paper reviews the evidence for potential gene: environment interactions in this process. Although the major preventable factor is maternal smoking, the effects of viral infection, nutrition, and indoor and outdoor pollution are reviewed. The survivors of preterm birth are another important cohort who may develop premature COPD in adult life. Early life events provide the substrate for COPD, with later tobacco smoking, and occasionally other exposures, pulling the trigger to produce COPD. A rigorous anti-smoking program is necessary to halt this spiral of lung destruction leading to COPD.