Sex and gender differences in lung development and their clinical significance

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Fetal and perinatal lung development

The structural design of the lung in both sexes is achieved through a complex developmental process that, far from being complete at birth, proceeds during childhood and includes organogenesis, fetal development, and postnatal development (Fig. 1). The lung starts to develop around the 26th day of gestation as a ventral diverticulum of the foregut. This embryonic stage is characterized by organogenesis, with the appearance of the first airways, and is considered to be complete between the first

Childhood and pubertal lung development

Height is the most important predictor of the level of lung function. During childhood, lung function increases linearly with height, resulting in nearly equal lung function between boys and girls. During puberty, a rapid nonlinear change in height and truncal height occurs. Because no new airway or alveolar development occurs after the age of 2 to 3 years, lung volume increases mainly by enlargement of the existing spaces. As the lungs lie within the thoracic cage, the enlargement is bounded

Smoking and its effect on fetal, perinatal, and childhood lung development

In utero smoke exposure seriously affects the lung development of the fetus. A cross-sectional study showed reduced levels of lung function as a result of in utero and childhood exposure to environmental tobacco smoke (ETS), but no significant differences between the boys and girls under study [25].

In a longitudinal study, Tager et al [26] investigated lung function growth during the first 18 months of life. They showed that maternal smoking during pregnancy was associated with significant

Adulthood

During puberty the child grows toward its adult stature, which is reached at the end of the second decade. At that moment, the individual reaches the maximal attainable level of lung function with maximally developed airways. In people between the ages of 20 and 40, we can identify a stable plateau phase in level of lung function with hardly any decline. At the age of approximately 40 years, lung function decline sets in, associated with the natural process of aging.

The lung tissue balances in

Smoking and its effect on adult lung function

In the year 2000, 37% of Dutch males and 29% of Dutch females smoked cigarettes [37]. The number of people that smoke was highest for people between the ages of 35 and 55 years (approximately 40% in men and 36% in women). Above the age of 65, the number of smokers was relatively low, specifically in elderly women (18% of those aged 65 to 75 years, 15% of those over the age of 75). The fact that women picked up the habit of smoking during the last decades will unfortunately increase the

Clinical implications

This article presents an overview of the current knowledge on factors in fetal, childhood, and pubertal life that may influence lung development and growth. From the earliest days imaginable, the development of the lung is influenced by many factors. Minor alterations in lung structural development during fetal life may have marked postnatal consequences [45]. Impairment in airway development, for example due to in utero smoke exposure, may increase the risk of childhood respiratory infections

Summary

Factors that affect airway growth–as early in development as in utero–seem to cause physiologic effects that can be persistent. Reduced airway function early in life does not necessarily result in persistent symptoms, but it does increase the risk of reduced lung function and the development of persistent airflow limitation in adult life, both in men and women. Normal lung growth varies with age and sex and is affected by a number of risk factors, which we have described. The importance of the

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