Can increased understanding of the role of lung development and aging drive new advances in chronic obstructive pulmonary disease?

To advance our ability to effect earlier diagnosis, prevent, and possibly restore healthy lung function in patients with chronic obstructive pulmonary disease (COPD) may require novel thinking. One avenue to explore is the concept of COPD as a trans-generational disease. Early development and COPD may be related first by failure of normal growth development leading to an increased risk of disease, and second by recapitulation of some developmental pathways that may be key to lung repair after injury. While we should be mindful that "aging" may not be only thought of as "late" development in a COPD context, the aging process in the lung is probably fundamentally different from emphysema. However, injury of the aging lung may result in emphysema. Finally, taking a more holistic view of COPD, aging and development in extrapulmonary contexts (e.g., musculoskeletal or immune systems) may also impact on COPD initiation and progression. Addressing the impact of development and the aging process on the natural history of the disease, both in men and in women, may open up research avenues that will drive new advances in disease classification, diagnosis, prognosis, and therapy for this chronic debilitating lung disease.