Promotion of lung health: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

Abstract

Lung-related research primarily focuses on the etiology and management of diseases. In recent years, interest in primary prevention has grown. However, primary prevention also includes "health promotion" (actions in a population that keep an individual healthy). We encourage more research on population-based (public health) strategies that could not only maximize lung health but also mitigate "normal" age-related declines-not only for spirometry but across multiple measures of lung health. In developing a successful strategy, a "life course" approach is important. Unfortunately, we are unable to achieve the full benefit of this approach until we have better measures of lung health and an improved understanding of the normal trajectory, both over an individual's life span and possibly across generations. We discuss key questions in lung health promotion, with an emphasis on the upper (healthier) end of the distribution of lung functioning and resiliency and briefly summarize the few interventions that have been studied to date. We conclude with suggestions regarding the most promising future research for this important, but largely neglected, area of lung research.

Figure 1.

A proposed paradigm shift in research on lung health. Current research tends to oversample individuals at the lower end of the lung health spectrum (however defined). This reflects the current emphasis on understanding disease states, which focuses measurement on either the population norm or on diseased individuals who are compared with the population norm. An alternative approach would be oversampling extremely healthy individuals. The paradigm shift is independent of the measurements undertaken and would apply to all forms of research, whether genomic, proteomic, cellular, physiologic, or patient centered (phenomenologic).

Figure 2.

Opportunities to promote lung health. The solid line shows normal age-related changes in lung function throughout life (normal curve estimated from data in Reference 12). The dotted line demonstrates opportunities to promote lung health: (a) improvements in lung development during the prenatal period and early childhood, (b) strategies to allow maximal lung growth during childhood, and (c) strategies to slow the “normal” age-related loss of lung function during adulthood.