Trajectories of Lung Function in Infants and Children: Setting a Course for Lifelong Lung Health

Abstract

For healthy individuals, it is increasingly accepted that lung function follows along an individual percentile established early in life and that the level of maximal function reached as a young adult can affect the subsequent development of lung disease that occurs with the normal aging process. This emphasizes the need to maximize early lung function. The trajectories of lung function are at least partially established by perinatal factors, including prematurity and in utero exposures (tobacco exposure, nutrition, inflammation, etc), although they can also be affected by a variety of additional factors and exposures throughout the life span. Whether lung function trajectories can be impacted or reset if established under suboptimal conditions is an unanswered question, offering new avenues for research. In this review, we will summarize important articles outlining lung function trajectories and linking pediatric lung function tests to adult lung function tests decades later. We will focus on perinatal factors and outline progress and opportunities for further investigation into the potential ability to reset trajectories to impact long-term lung health.

Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age

“…These recent findings suggest that ex-preterm children with early reduced lung function compared to term controls could improve lung function over time, especially in absence of BPD ( 15 , 25 , 27 ). According to these findings, we speculate that the lung function was normal in our study population at 11 years of age probably because their lung function improved over time.…”

What is BPD today and in the next 50 years?

“…Is there an increase in airway smooth muscle mass after neonatal interventions, as has been well demonstrated in neonatal rodent models (30,31)? Regardless of etiology there is increasing concern regarding the vulnerability of airway function as premies mature into advanced adulthood (5). Given that lung function peaks in early adulthood prior to a slow but steady decline, we need to warn this already vulnerable population of former premies, and their caregivers, that they are at very high risk if exposed to adverse respiratory stimuli such as smoking exposure.…”

Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

“…There is some evidence that severity of airflow limitation during early childhood could not only be predictive of lower pulmonary function in later life but also may predict increased risk of respiratory morbidities [ 22 , 23 ]. Over time, it is possible that pulmonary function in preterm infants follows similar trajectories as their full-term counterparts but with a lesser degree of peak in pulmonary function and potentially a more rapid decline in old age [ 21 , 24 , 25 ].…”