OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil VarkeyLung function trajectories and chronic obstructive pulmonary disease current understanding and knowledge gapsKrishnan, Jamuna K.; Martinez, Fernando J. Author Information Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, New York, USA Correspondence to Jamuna K. Krishnan, MD, Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, 1305 York Avenue, Box 96, 10th fl Rm Y-1047, New York, NY 10021, USA. Tel: +1 646 962 2738; e-mail: [email protected] Current Opinion in Pulmonary Medicine: March 2018 - Volume 24 - Issue 2 - p 124-129 doi: 10.1097/MCP.0000000000000456 Buy Metrics Abstract Purpose or review Population-based studies have shown a significant heterogeneity in patients with chronic obstructive pulmonary disease (COPD), regarding both the attainment of maximal lung function and the subsequent decline over time. This review will highlight recent advances in the understanding of lung function trajectory in COPD, focusing on factors that influence peak adult lung function, markers of accelerated lung function decline and pharmacologic interventions in early phases of the disease. Recent findings Recent data have shown that individuals with lower lung function early in life will go on to develop lower forced expiratory volume in 1 s (FEV1) in adulthood. Smoking can amplify the effect of specific childhood exposures on maximal adult lung function. Clinical symptoms such as chronic mucous hypersecretion and the biomarker club cell secretory protein have been associated with lung function decline over time. New computed tomography imaging markers also show promise as a way to detect early small airway disease, but need to be examined more longitudinally. In addition to these advances, a slower decline in FEV1 has been demonstrated in two randomized clinical trials studying tiotropium and inhaled fluticasone. Summary A better understanding of lung function development and eventual decline in those at risk for progression to COPD will aide in a precision medicine approach, in which markers for those at risk of low maximal lung function and accelerated decline are identified. Targeted therapy can then be used early to modify disease activity and outcomes. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.