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People in low-and-middle income countries are more vulnerable to developing COPD as a result of early life experiences

Last Update 06/04/2021

A new article reviews the evidence that suggests that people living in LMICs are more vulnerable to developing COPD due to early life experiences.


More than 90% of COPD-related deaths occur in low-income and middle-income countries (LMICs).  A new article in the Nature Partner Journal: Primary Care Respiratory Medicine reviews some of the recent evidence that suggests that people living in LMICs are more vulnerable to developing COPD as a result of early life experiences, compared to those from high-income countries.

A person’s lungs continue to develop throughout their childhood until early adulthood. Therefore, a person’s lung function is at its peak at around 20-25 years of age, before it starts to get worse with older age. Chronic obstructive lung disease (COPD) is a condition where peoples’ lung function drops below a certain level and the person experiences symptoms such as breathlessness and coughing.

For many patients, their COPD will be due to their lung function getting worse more quickly than that of a healthy person, usually caused by smoking or exposure to air pollution in their adult life. However, some people are vulnerable to developing COPD because they reach a lower “peak” in their lung function. The condition can be caused by a combination of both of these factors.

Often when a person has a lower peak lung function, it is caused by early life factors that can affect lung growth. These include:   

  • if they breathed in polluted air as they were growing up (including second-hand tobacco smoke and household air pollution)
  • if their mother had asthma, diabetes or didn’t have enough to eat when they were pregnant
  • if they were born prematurely, had a low birth weight, or had diseases during childhood

A lower peak lung function is more of a problem in LMICs because these factors are more common than in high-income countries. It is also more difficult to control this type of COPD, and people in LMICs might also find it more difficult to access healthcare and reliable health information.

According to the article’s authors, prevention is key to reducing the impact of COPD in LMICs, and it must start before birth and continue throughout childhood. For those who do develop COPD, education and pulmonary rehabilitation could be helpful, cost-effective ways of managing symptoms and slowing down disease progression.

Read the full article.

Read our factsheet on living well with COPD.

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