Identifying and preventing the progression of asthma to chronic obstructive pulmonary disease

Persistent asthma is associated with early lung function loss and persistent obstruction. Recent data suggest that even mild to moderate asthma is associated with reduced lung growth trajectories. Factors underlying this phenomenon include genetic and environmental causes and their interaction via epigenetic mechanisms. Beyond these mechanisms, prenatal factors may also play a role in the determinants of lung growth and subsequent risk of asthma and chronic obstructive pulmonary disease. It appears clear from the existing data that persistent asthma is associated with altered lung function trajectories, persistent obstruction, and progressive decline in adulthood. Although primary prevention has been elusive, hope remains as new therapeutic options from microbiome data arise. Secondary prevention strategies focus on early recognition of lung function loss and prevention of further loss from noxious inhalant exposures. Further research is needed to understand the mechanisms underlying improved lung growth and prevention or improvement in the usual trajectory of lung function loss associated with aging.