Promotion of Lung Health: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

Abstract

Lung-related research primarily focuses on the etiology and management of diseases. In recent years, interest in primary prevention has grown. However, primary prevention also includes "health promotion" (actions in a population that keep an individual healthy). We encourage more research on population-based (public health) strategies that could not only maximize lung health but also mitigate "normal" age-related declines-not only for spirometry but across multiple measures of lung health. In developing a successful strategy, a "life course" approach is important. Unfortunately, we are unable to achieve the full benefit of this approach until we have better measures of lung health and an improved understanding of the normal trajectory, both over an individual's life span and possibly across generations. We discuss key questions in lung health promotion, with an emphasis on the upper (healthier) end of the distribution of lung functioning and resiliency and briefly summarize the few interventions that have been studied to date. We conclude with suggestions regarding the most promising future research for this important, but largely neglected, area of lung research.

Early chronic obstructive pulmonary disease: definition, assessment, and prevention

“…24 Airway branching is completed by the 17th week of gestation. Airways increase in length and diameter until young adulthood, but, generally, new airways do not form.…”

“…Identification of modifiable risk factors for COPD has suggested strategies to mitigate the risk. 24 However, the mechanistic basis for the associations between risk factors and disease is generally not understood. Whether correction of risk factors will reduce disease incidence, therefore, has to be assessed empirically.…”

Association between Cardiorespiratory Fitness and Lung Health from Young Adulthood to Middle Age

“…The trajectory of decline following attainment of peak lung function is variable. Although cigarette smoking is a well-studied contributor to loss of lung function (1)(2)(3), there are limited data on factors associated with maintenance of lung health (4).…”

Proteostasis and Energetics as Proteome Hallmarks of Aging and Influenza Challenge in Pulmonary Disease

“…While the pulmonary tissue is capable of surviving influenza-associated challenges, elderly patients have an increased risk of developing agerelated disorders including persistent lung injury, skeletal muscle dysfunction leading to immobility, dementia, and cognitive impairment. Although recent transcriptomic and proteomics analyses have begun to highlight differences among the more than 40 cell types that comprise the lungs (3,7) as well as their respective response to aging (7), the complexity of this organ complicates our ability to ascertain the underlying cause for this increased susceptibility to pneumonia and other diseases (6,8,9).…”

“…The long-term health of pulmonary tissue (2,6,8,(10)(11)(12)(13) is inextricably linked to the sustainability of the protein fold and its function (14)(15)(16)(17)(18). Protein homeostasis or proteostasis (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), is a collection of integrated biological pathways, referred to as the proteostasis network (PN), that balance protein biosynthesis, folding, trafficking, post-translational modifications and clearance through multiple degradation pathways in response to endogenous and exogenous folding stress during aging (6,16,(18)(19)(20)(21)23,(25)(26)(27)29,30).…”