Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
National Heart and Lung Institute, Imperial College, London, UK.
Lancet. 2015 Mar 7;385(9971):899-909. doi: 10.1016/S0140-6736(14)60446-3. Epub 2014 Aug 11.
Chronic obstructive pulmonary disease is mainly a smoking-related disorder and affects millions of people worldwide, with a large effect on individual patients and society as a whole. Although the disease becomes clinically apparent around the age of 40-50 years, its origins can begin very early in life. Different risk factors in very early life--ie, in utero and during early childhood--drive the development of clinically apparent chronic obstructive pulmonary disease in later life. In discussions of which risk factors drive chronic obstructive pulmonary disease, it is important to realise that the disease is very heterogeneous and at present is largely diagnosed by lung function only. In this Review, we will discuss the evidence for risk factors for the various phenotypes of chronic obstructive pulmonary disease during different stages of life.
慢性阻塞性肺疾病主要与吸烟有关，影响着全球数百万人，对个体患者和整个社会都有很大的影响。尽管这种疾病在 40-50 岁左右才表现出临床症状，但它的起源可能在生命早期就已经开始了。生命早期的不同危险因素——即在子宫内和儿童早期——导致了日后出现明显的慢性阻塞性肺疾病。在讨论哪些危险因素会导致慢性阻塞性肺疾病时，重要的是要认识到这种疾病具有很强的异质性，目前主要仅通过肺功能来诊断。在这篇综述中，我们将讨论在生命的不同阶段，不同慢性阻塞性肺疾病表型的各种危险因素的证据。
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