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Early Life Origins of Asthma: A Review of Potential Effectors

Bobolea I1-4*, Arismendi E3-4*, Valero A1-4, Agustí A1-4

1Respiratory Institute, Hospital Clínic, Barcelona, Spain
2University of Barcelona, Spain
3Institut d’Investigacio Biomedica August Pi i Sunyer (IDIBAPS)
4Centro Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Spain
*co-primary authors

J Investig Allergol Clin Immunol 2019; Vol. 29(3)
doi: 10.18176/jiaci.0361

There is currently growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, COPD and low lung function later in life. In fact, from conception to death there are continuous, dynamic numbers of gene-environment interactions that determine two fundamental biologic processes, lung development and lung ageing. Over 130 birth cohorts have been initiated in the last 30 years. These birth cohorts have improved our understanding of asthma inception, progression and persistency. In this review, we summarize the main data upon those early life events proven to determine later development and persistence of asthma, such as maternal atopy or smoking, preterm birth/ bronchopulmonary dysplasia, or infections, nutrition and obesity, smoking and other environmental exposures in childhood and adolescence.
Some of these factors are obviously impossible to prevent or eliminate; others, in exchange, have been proven to have a protective role, and current research is aimed to optimally enhance them. The available prophylactic measures are also revised here. In case of environmental pollution for instance, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas.
Future research should focus on better understanding these complex interactions, in order to develop and enhance effective preventive therapeutic measures. 

Key words: Atopy, Asthma, Lung Function, Pregnancy, Prematurity, Obstructive Airway Disease, Airway Hyperreactivity