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Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. We aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease.

During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements.

Lung development starts in utero and continues during childhood through to adolescence, reaching its peak in early adulthood. This growth is followed by gradual decline due to physiological lung ageing. Lung-function development can be altered by several host and environmental factors during the life course. As a result, a range of lung-function trajectories exist in the population. Below average trajectories are associated with respiratory, cardiovascular, metabolic, and mental health comorbidities, as well as with premature death. This Review presents progressive research into lung-function trajectories and assists the implementation of this knowledge in clinical practice as an innovative approach to detect poor lung health early, monitor respiratory disease progression, and promote lung health. Specifically, we propose that, similar to paediatric height and weight charts used globally to monitor children's growth, lung-function charts could be used for both children and adults to monitor lung health status across the life course. To achieve this proposal, we introduce our free online Lung Function Tracker tool. Finally, we discuss challenges and opportunities for effective implementation of the trajectory concept at population level and outline an agenda for crucial research needed to support such implementation.

BackgroundRecent studies suggest that lung microbiome dysbiosis, the disease associated disruption of the lung microbial community, might play a key role in chronic obstructive pulmonary disease (COPD) exacerbations. However, characterising temporal variability of the microbiome from large longitudinal COPD cohorts is needed to better understand this phenomenon.MethodsWe performed a 16S ribosomal RNA survey of microbiome on 716 sputum samples collected longitudinally at baseline and exacerbations from 281 subjects with COPD at three UK clinical centres as part of the COPDMAP consortium.ResultsThe microbiome composition was similar among centres and between stable and exacerbations except for a small significant decrease of Veillonellaat exacerbations. The abundance of Moraxellawas negatively associated with bacterial alpha diversity. Microbiomes were distinct between exacerbations associated with bacteria versus eosinophilic airway inflammation. Dysbiosis at exacerbations, measured as significant within subject deviation of microbial composition relative to baseline, was present in 41% of exacerbations. Dysbiosis was associated with increased exacerbation severity indicated by a greater fall in forced expiratory volume in one second, forced vital capacity and a greater increase in CAT score, particularly in exacerbations with concurrent eosinophilic inflammation. There was a significant difference of temporal variability of microbial alpha and beta diversity among centres. The variation of beta diversity significantly decreased in those subjects with frequent historical exacerbations.ConclusionsMicrobial dysbiosis is a feature of some exacerbations and its presence, especially in concert with eosinophilic inflammation, is associated with more severe exacerbations indicated by a greater fall in lung function.Trial registration numberResults, NCT01620645.

Approximately 1.2 million people in the UK suffer from chronic obstructive pulmonary disease (COPD), leading to 115,000 unplanned hospital admissions per year. Smoking remains the leading cause (over 70% of cases) of COPD in high income countries, but globally, especially in low-middle income countries only 30–40% of cases are attributed to smoking. COPD should be suspected among individuals with typical symptoms (dyspnoea, cough, wheeze, recurrent chest infections) but diagnosis requires confirmatory obstructive spirometry. Clinicians should aim to exclude alternative diagnoses, grade disease severity, personalise treatment and identify co-morbidities. The mainstays of COPD management are smoking cessation, vaccination, inhaled therapies and pulmonary rehabilitation. Therapy should particularly target symptom burden and exacerbation frequency. Recently developed interventional techniques and emerging evidence for the use of monoclonal antibody therapies appear promising. That said, the current frontier for improving outcomes might lie in a better understanding of disease trajectories, prompt diagnosis and earlier intervention to limit progressive lung function decline.