Lung function is essential for good health and compromises in this capacity have a large and broad effect on the ability to lead a full and satisfying life. The NHLBI Lung Division convened a workshop in September 2013, at which pulmonary experts provided state-of-the-art status of prevention for several specific lung diseases, identified key questions, and considered approaches to facilitate prevention. The results of the workshop have been published in a special issue of the Annals of the American Thoracic Society.
Workshop participants distinguished two major concepts as uniquely important to primary prevention of lung disease: the promotion of lung health and the prevention of lung disease. The lung continues to develop in postnatal, early childhood, and young adult life, after which time lung function declines with aging. This offers intriguing opportunities, not only for promotion of healthy lungs, but also for interventions for development of healthier lungs by accelerating growth and/or slowing decline. Likewise, successful prevention of lung diseases requires clear demarcation of the pre-disease state from the onset of disease. In this context, a major barrier to health promotion and disease prevention is the current lack of biomarkers or proxy measures of lung health or disease. There was consensus that to achieve prevention, it is essential to more fully and comprehensively define what is lung health across the life course. This topic became the cornerstone of discussions and framed the approaches for metrics of prevention outcomes. The life course approaches take into consideration exposures, (i.e. biological, behavioral, and psychosocial) that operate across an individual’s life as well as across generations.
In addition to lung health, specific diseases under review and discussion included: asthma, bronchopulmonary dysplasia, chronic obstructive lung disease, cystic fibrosis, interstitial lung disease, and pulmonary hypertension. Generally, the recommendations from the workshop describe an approach to identify both the at-risk patient and the response that marks a shift from health to disease, as well as providing general strategies to begin to implement primary prevention interventions. A number of key points emerged during the workshop, which were common across disease areas, and had broad directive influence to establish programs of prevention.
These broad recommendations, along with the specific recommendations in the workshop summaries provide actionable next steps, which include identification of health, pre-disease, and disease phenotypes and endotypes, development of proxy measures such as genomic and proteomic biomarkers and imaging, determination of risk factors for disease in the general and high-risk populations, and strategies for development of clinical trials that will provide the basis for a paradigm changing approach to promote and enhance lung health and prevent chronic lung disease. We have already begun to see significant benefits of early identification of at-risk individuals with cystic fibrosis. The overall goal is to detect at-risk individuals using quantitative modifiable biomarkers that will allow effective prevention of a wide-variety of lung diseases and ensure optimal lung health over the entire life of an individual. A workshop executive summary of this workshop was published in the Annals of the American Thoracic Society (Vol. 11, No. Supplement 3 (2014), pp. S123-S124).