On Genetics, Lung Developmental Biology, and Adult Lung Function

Koppelman, Gerard H.; Guerra, Stefano

doi:10.1164/rccm.202006-2123ed

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Primary prevention aims at preventing a disease before it occurs by eliminating exposures to risk factors and/or increasing resistance to it should exposure occur. Primary prevention of COPD is key in children and adolescents (Figure 1) but likely relates more to public health measures than to therapeutic interventions, although we acknowledge that boosting "catch-up" of impaired lung function in early life may deserve specific investigation (8,24,35,36). Secondary prevention aims to reduce progression once disease has already manifested.…”

Section: Primary Secondary and Tertiary Preventionmentioning

confidence: 99%

Treatment Trials in Young Patients with Chronic Obstructive Pulmonary Disease and Pre–Chronic Obstructive Pulmonary Disease Patients: Time to Move Forward

Martínez

Agustí

Celli

et al. 2022

Am J Respir Crit Care Med

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Chronic Obstructive Pulmonary Disease is the end-result of a series of dynamic and cumulative gene-environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts we propose therapeutic trials in two major groups of subjects: those "young" individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider "young" COPD those patients in the age range of 20-50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized clinical trials (RCTs). We highlight the need of RCTs focused on young COPD or Pre-COPD patients to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCTs design including potential outcomes such as lung function, patient reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in (1) young adults with COPD and (2) those with pre-COPD at any age.

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Section: Primary Secondary and Tertiary Preventionmentioning

confidence: 99%

Treatment Trials in Young Patients with Chronic Obstructive Pulmonary Disease and Pre–Chronic Obstructive Pulmonary Disease Patients: Time to Move Forward

Martínez

Agustí

Celli

et al. 2022

Am J Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…Between 4-12% of individuals in the general population fail to reach a forced expiratory volume in one second (FEV 1 ) peak in early adultwood within the predicted "normal range" for their age and sex 5 . This can be due to one or more genetic risk factors [7][8][9] and/or environmental conditions in utero and after birth 4,10 , including maternal tobacco smoking and under-nourishment, premature birth, intrauterine growth restriction and broncho-pulmonary dysplasia, air pollution exposure, lower respiratory tract infections and active smoking during adolescence. Childhood "asthma" is also often considered a risk factor for low lung function in early adulthood 11 but the diagnosis of "asthma" in young children is difficult to establish objectively and, although the presence of "asthma" can conceivably impair lung growth, it is also possible that any other process impairing lung growth can cause similar, nonspecific, symptoms than those traditionally associated to asthma (dyspnoea, cough, wheezing).…”

Section: Altered Lung Growthmentioning

confidence: 99%