Lung development and early origins of childhood respiratory illness.

In the last two decades, 5 cohort studies have been initiated to examine the association of infant respiratory function with genetic and environmental risk factors, as well as with subsequent lower respiratory illness in early childhood. While the current complexity of respiratory function tests in this age group precludes study samples with sufficient power to examine more complex issues, information from these studies has provided an exciting adjunct to that available from the longer cohort studies. Premorbid alterations in airway function or lung development increase the risk of wheezing lower respiratory illnesses during the preschool years and the risk of impaired airway function at 5-6 years of age. In addition, gender differences in airway function and the response to maternal smoking have been observed. Larger collaborative population-based studies are needed to explore the environmental, genetic and immunological mechanisms responsible, but will depend on the development of less invasive tests of airway function appropriate for use in healthy infants.