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COPD as a disease of children: hype or hope for better understanding?
  1. David M Mannino
  1. Correspondence to Dr D M Mannino, Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, 121 Washington Avenue, Lexington, KY 40536, USA; dmannino{at}

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“Train up a child in the way he should go: and when he is old, he will not depart from it.” Proverbs 22:6

I have three children, two of whom are adults, and the third of whom is now taller than me. These children, despite sharing similar genes, are all very different in their personalities, demeanours, likes and dislikes. I am convinced that almost all of the traits they now have as adults, or near adults, are pretty much what they emerged from the womb with. Other parents I have discussed this observation with have similar stories—it may be that most of what affects us in adulthood has been established before we start grade school.

Almost all of the epidemiological studies of chronic obstructive pulmonary disease (COPD) have focused on risk factors in adulthood such as cigarette smoking, occupational exposures, exposures to biomass smoke and respiratory infections.1 2 3 4 COPD is clearly a disease that manifests itself in adulthood with a peak onset of incidence in the fifth …

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