Prevention of Chronic Obstructive Pulmonary Disease

COPD is defined as a preventable condition given that environmental/nongenetic factors play a crucial role in the initiation and development of most of the disease’s clinical expressions, which are possibly related to several interconnected preventable traits. Most of the current evidence on COPD pathogenesis originates from cigarette smoking, and to a lesser extent exposure to outdoor, indoor, and occupational pollutants. Therefore, currently available evidence regarding prevention strategies, and particularly primary prevention, is mainly related to these preventable traits. Smoking cessation has the greatest capacity for influencing the natural history of COPD, and smoking avoidance and cessation remains the only proven primary prevention strategy for chronic respiratory diseases. However, even25 years after the publications of the WHO regarding cigarette smoking, there is still no solid evidence indicating that this convention has globally reduced cigarette consumption. Primary prevention of adverse air pollution effects has been focused on developing ambient air quality guidelines; however, many countries have lacked in the enforcement of standards. BMF air pollutants measured in homes in low-income countries have been greater than the corresponding values in high-income countries, with evidence of a consistent dose-response relationship. Improving cooking fuels and kitchen ventilation could potentially be effective in decreasing COPD incidence in these conditions. However, although primary prevention remains fundamental for COPD and for all chronic diseases, the evidence of its feasibility and effectiveness remains weak. This weakness is emphasized by a National Institutes of Health (NIH) workshop report that provides a detailed list of future research/actions necessary to properly address this important issue (Box 1). Many strategies have been developed for the many identified preventable trait; however, although these are effective in theory, there are no tangible changes in real-world/large-scale conditions. In addition, there is current accumulating evidence highlighting that the origins of some chronic diseases, including COPD, could already be present shortly after birth and that primary prevention of chronic obstructive respiratory diseases should probably be started during pregnancy and the first years of life.