From ideal respiratory health to chronic lung disease: indicators of impaired respiratory health.

introductionIdeal respiratory health and chronic respiratory disease exist on a continuum. Between these two extremes lies an intermediate state of impaired respiratory health, characterized by clinical phenotypes that exist along the causal pathway. Identifying individuals with intermediate phenotypes of impaired respiratory health offers an opportunity to intercept progression to chronic respiratory disease. AREAS COVERED: In this review, we identify parameters associated with impaired respiratory health, including respiratory symptoms and illnesses, abnormal lung physiology, imaging abnormalities, and blood biomarkers. We then synthesize evidence linking these parameters to future respiratory impairment. EXPERT OPINION: Drawing inspiration from advances in cardiovascular disease prevention, the respiratory field must adopt a holistic framework that considers the likely shared biologic mechanisms underpinning chronic lung diseases. Effective disease prevention depends on a multi-omic approach that integrates clinical, physiologic, imaging, and molecular data to identify individuals at increased risk for chronic respiratory disease. Prospective evaluation of these at-risk individuals can be utilized to evaluate the impact of targeted preventative strategies.