A Life Course Approach to Lung Function Impairment and COPD

Abstract Chronic obstructive pulmonary disease (COPD), an adverse outcome of chronic lung function impairment, was traditionally considered a disease of adult male smokers that resulted only from accelerated lung function decline. That dogma has now been overturned with recent evidence showing smoking is not the only risk factor, and lower lung function trajectories starting from early life can lead to COPD. More specifically, recent studies have provided evidence of three distinct adverse lifetime lung function trajectories that lead to COPD. In parallel, there is increasing recognition in the field of COPD that the disease imposes a significant burden on females and that females may even be more susceptible to certain risk factors that play a role in COPD aetiology. In addition, female reproductive factors that act throughout the lifespan are now emerging as novel risk factors for lung function deficits and COPD. Overall, a life course approach to reduce lung function impairment will enhance lung health of the community in future decades, and more investigations into potentially modifiable female reproductive adverse exposures are recommended to develop female-specific interventions to promote lung health. This chapter summarises the development and ageing of lungs, the development of COPD, and risk factors throughout the life course, while highlighting the issues specific to females in these areas.