Primary prevention of COPD starts earlier than you think

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Prevention must precede first signs of disease

COPD is a cumulative expression of exposures that begin before birth and unfold during the course of life. In daily work, respiratory healthcare professionals mostly do secondary and tertiary prevention, meaning early detection of disease and preventing disease progression. By the time when COPD comes clinically visible, the origins of the disease may have been set decades earlier.

Therefore the focus should be moved towards primary prevention. For primary prevention to be effective, lung health should be protected for the whole population and not just individual patients. COPD is mostly considered as a disease that occurs in mid- or late adulthood and is related to smoking.  Looking from a different perspective, COPD is not just a disease of aging lungs.

Pekka Ojasala
Medical Advisor, Chiesi Nordic

Lung function: A poor start can have life long implications

Lung function is a reflection of life events, shaping the development, growth and decline of the function. This trajectory begins already in utero¹. Low early lung growth or accelerated decline are linked to higher risk of adult COPD.  It is estimated that around 50% of adult COPD develops in those who never reach the normal peak of lung function. The physiological and epidemiological evidence was summarized in a clinical review by Andrew Bush, stating:²

Lifetime lung function is determined by the end of the preschool years

Andrew Bush, professor of Paediatric Respirology, Imperial college, UK

Childhood disadvantage factors impacts future lung function

A European study³ showed that «childhood disadvantage factors» such as asthma (own or parental), maternal smoking and severe lower respiratory tract infection (LRTI) before school age was significantly associated with lower FEV₁ and steeper FEV₁ decline. The influence of these disadvantage factors were as large as current heavy smoking in terms of lung function decline and COPD diagnosis in later life.

Similar observations were made by the CAMP Research group who found, that in patients with mild-to-moderate childhood asthma, 75% had abnormal lung function development.⁴ Normal peak of lung function was only obtained by 50% and 25% had an early decline in lung function. A Danish study⁵ found that asthma-like symptoms in early childhood doubled the risk for COPD and COPD medication.  

Points for primary prevention

Most exposures causing impairment of the lung development and long term health occur early and can be prevented. Primary prevention is a lifelong, cross-disciplinary, societal responsibility.

Pekka Ojasala
Medical Advisor, Chiesi Nordic

ID 20301-11.03.2026