Faner Rosa, Cho Michael H, Koppelman Gerard H, Melén Erik, Verleden Stijn E, Dharmage Shyamali C, Meiners Silke, Agusti Alvar
Departament de Biomedicina, Universitat de Barcelona. Fundació Clinic Recerca Biomedica-Institut Agust Pi i Sunyer (FCRB-IDIBAPS), Centro Investigación Biomedica en Red enfermedades Respiratorias (CIBERES), Barcelona, Spain
ICREA - Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
Eur Respir Rev. 2025 Jul 9;34(177). doi: 10.1183/16000617.0243-2024. Print 2025 Jul.
COPD is "a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli that cause persistent, often progressive, airflow obstruction". COPD has been traditionally associated with tobacco smoking and accelerated lung function decline. However, our understanding of the pathogenesis of COPD has changed significantly over the past few years due to the recognition that different lung function trajectories starting in early life and progressing across the lifespan are also important pathways to COPD. Further, today, it is well accepted that there are multiple genetic, host and environmental factors (, aetiotypes) that can cause COPD and contribute to its clinical heterogeneity. Here, we review current understanding of the environmental, genomic and immune factors associated with the early-life origins of COPD. We also discuss the current knowledge gaps and how this new knowledge can facilitate earlier detection and disease interception of COPD across the lifespan, thus reducing its disease burden and improving the well-being and prognosis of COPD patients.
慢性阻塞性肺疾病（COPD）是“一种异质性肺部疾病，其特征为由于气道和/或肺泡异常导致慢性呼吸道症状，进而引起持续的、通常呈进行性的气流受限”。传统上，COPD与吸烟及肺功能加速下降有关。然而，在过去几年中，由于认识到从生命早期开始并贯穿一生的不同肺功能轨迹也是导致COPD的重要途径，我们对COPD发病机制的理解发生了显著变化。此外如今人们普遍认为，有多种遗传、宿主和环境因素（即病因类型）可导致COPD并促成其临床异质性。在此，我们综述了目前对与COPD早期起源相关的环境、基因组和免疫因素的理解。我们还讨论了当前的知识空白，以及这些新知识如何能够促进在整个生命周期内对COPD进行更早的检测和疾病干预，从而减轻其疾病负担，改善COPD患者的健康状况和预后。
