• COPD pathology

Lung function is better than systolic blood pressure in predicting all-cause mortality and surprisingly circulatory disease mortality.1 It is a strong predictor of shorter survival even among people who have never smoked and in those with no symptoms of lung disease.1–3 A lung function lower than normal is usually the result of poor lung development in early life or a rapid decline of lung function with age during adulthood or both.4–6

The best established risk factor for rapid decline in lung function is tobacco smoking,7 but obesity, occupational exposures and socioeconomic position-related factors may also play a key role.8–12 In addition, there is evidence showing that people with asthma or hypertension tend to see a faster deterioration of their lung function.5 13 However, most data on this topic come from studies carried out mainly in high-income countries bringing into question whether the same is true in low/middle-income countries, where the prevalence of tobacco smoking has been lower and other environmental factors may be of greater relevance.

Miele et al 14 report findings of the CRONICAS study where they investigated whether prebronchodilator lung function is affected by factors such as urbanisation, altitude, use of biomass for cooking, asthma, chronic bronchitis, history of pulmonary TB, hypertension, body mass index (BMI), diabetes and systemic C-reactive protein levels. …