There is increasing evidence that chronic obstructive pulmonary disease (COPD) is not
simply a disease of old age that is largely restricted to heavy smokers, but may be
associated with insults to the developing lung during foetal life and the first few years
of postnatal life, when lung growth and development are rapid. A better understanding of
the long-term effects of early life factors, such as intrauterine growth restriction,
prenatal and postnatal exposure to tobacco smoke and other pollutants, preterm delivery
and childhood respiratory illnesses, on the subsequent development of chronic respiratory
disease is imperative if appropriate preventive and management strategies to reduce the
burden of COPD are to be developed. The extent to which insults to the developing lung are
associated with increased risk of COPD in later life depends on the underlying cause,
timing and severity of such derangements. Suboptimal conditions in utero
result in aberrations of lung development such that affected individuals are born with
reduced lung function, which tends to remain diminished throughout life, thereby
increasing the risk both of wheezing disorders during childhood and subsequent COPD in
genetically susceptible individuals. If the current trend towards the ever-increasing
incidence of COPD is to be reversed, it is essential to minimize risks to the developing
lung by improvements in antenatal and neonatal care, and to reduce prenatal and postnatal
exposures to environmental pollutants, including passive tobacco smoke. Furthermore, adult
physicians need to recognize that lung disease is potentially associated with early life
insults and provide better education regarding diet, exercise and avoidance of smoking to
preserve precious reserves of lung function in susceptible adults. This review focuses on
factors that adversely influence lung development in utero and during the
first 5 years of life, thereby predisposing to subsequent COPD.