Women's and Children's Health Dept, University of Padua, Padua, Italy.
Dept of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Respir J. 2014 Dec;44(6):1682-96. doi: 10.1183/09031936.00084114. Epub 2014 Oct 16.
Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease often originate early in life. In addition to a genetic predisposition, prenatal and early-life environmental exposures have a persistent impact on respiratory health. Acting during a critical phase of lung development, these factors may change lung structure and metabolism, and may induce maladaptive responses to harmful agents, which will affect the whole lifespan. Some environmental factors, such as exposure to cigarette smoke, type of childbirth and diet, may be modifiable, but it is more difficult to influence other factors, such as preterm birth and early exposure to viruses or allergens. Here, we bring together recent literature to analyse the critical aspects involved in the early stages of lung development, going back to prenatal and perinatal events, and we discuss the mechanisms by which noxious factors encountered early on may have a lifelong impact on respiratory health. We briefly comment on the need for early disease biomarkers and on the possible role of "-omic" technologies in identifying risk profiles predictive of chronic respiratory conditions. Such profiles could guide the ideation of effective preventive strategies and/or targeted early lifestyle or therapeutic interventions.
慢性阻塞性呼吸道疾病，如哮喘和慢性阻塞性肺疾病，通常在生命早期就开始出现。除了遗传易感性外，产前和生命早期的环境暴露对呼吸健康也有持久的影响。这些因素在肺部发育的关键阶段发挥作用，可能会改变肺部结构和代谢，并可能导致对有害剂的适应性反应，从而影响整个生命周期。一些环境因素，如吸烟、分娩方式和饮食，可以改变，但更难影响其他因素，如早产和早期接触病毒或过敏原。在这里，我们汇集了最近的文献，分析了肺部发育早期涉及的关键方面，可以追溯到产前和围产期事件，并讨论了早期遇到的有害因素如何对呼吸健康产生终身影响的机制。我们简要评论了早期疾病生物标志物的必要性，并讨论了“组学”技术在确定预测慢性呼吸道疾病风险特征方面的可能作用。这些特征可以指导制定有效的预防策略和/或有针对性的早期生活方式或治疗干预措施。
