At the Root: Defining and Halting Progression of Early Chronic Obstructive Pulmonary Disease

Twenty‐five years of Respirology: Advances in COPD

“…However, it is now known that lung development plays an equally important role in disease pathogenesis and progression. For most, peak lung function is achieved in early adulthood, after which lung function gradually declines with ageing . There is compelling evidence that individuals born preterm or with a very low birthweight, or who experience recurrent or severe lung infection during childhood, never reach their full airway growth potential in adolescence and early adulthood, which significantly increases their risk of COPD in adult life .…”

“…Some areas of active investigation in early COPD include airway inflammation (innate and adaptive immunity), lung dysbiosis, mucous plugging, autoimmunity and respiratory infections. There are also active efforts to develop novel imaging and physiological technologies to accurately diagnose airway disease in susceptible individuals before these are detectable using standard spirometry …”

“…For most, peak lung function is achieved in early adulthood, after which lung function gradually declines with ageing. 2 There is compelling evidence that individuals born preterm or with a very low birthweight, or who experience recurrent or severe lung infection during childhood, never reach their full airway growth potential in adolescence and early adulthood, which significantly increases their risk of COPD in adult life. 3 Such individuals will develop COPD later on in life, even though their rate of lung function loss is the same as that of the average person in the community.…”

“…There are also active efforts to develop novel imaging and physiological technologies to accurately diagnose airway disease in susceptible individuals before these are detectable using standard spirometry. 2 There has also been significant advancements in the genetics of COPD beyond alpha-1-antitrypsin deficiency. It is now known that approximately one-third of the risk in COPD can be attributed to genetics.…”

Rebuttal From Dr Han

“…Identifying patients with early-stage disease at risk for disease progression and developing targeted disease-modifying therapies represent the next frontier in COPD. 6 Imaging can be very helpful in this regard given the prevalence of imaging abnormalities even in mild disease 7 and its ability to predict FEV 1 decline. 3 If used in the development and testing of disease-modifying therapies, CT imaging holds the potential to serve as a platform for the development of personalized health approaches in COPD in the near future.…”