Dysanapsis as a Determinant of Lung Function in Development and Disease

Elizabeth A. McGinn, Erica W. Mandell, Bradford J. Smith, Joseph W. Duke, Andrew Bush, Steven H. Abman

Research output: Contribution to journalArticlepeer-review

Abstract

Although it is not new terminology, the concept of dysanapsis has gained recent traction in clinical relevance, especially with increased awareness of perinatal origins of adult respiratory disease. Recent reviews have discussed developmental trajectories in BPD, COPD, and asthma, demonstrating that lung function tracks along a consistent percentile from infancy to childhood to young adulthood (2, 106). Multiple studies demonstrate abnormal airflow limitations in early life may be related to adulthood disease predisposition (107–110). Dysanapsis may be an unexplored link in these trajectories. Existing literature suggests that, along the airway:parenchymal-size ratio spectrum, dysanapsis may exist in humans with phenotypically normal lung function. More pronounced dysanapsis may be associated with risk of disease. More studies are needed for serial assessments of changes in lung function over the lifespan to discern the impact of early markers of dysanapsis on subsequent respiratory outcomes. Many knowledge gaps exist in characterization and understanding of the pathogenesis and physiologic basis of dysanapsis. Despite numerous studies of lung function during development, few studies directly address the structural nature of dysanapsis. More preclinical studies are needed to more fully explore mechanisms that contribute to differential growth of the airways and distal lung, as well as functional implications, especially in animal models of BPD, asthma, and COPD. Studies are especially needed to examine the impact of perinatal stress and the subsequent predisposition for adult lung disease. Dysanapsis is a useful physiologic concept that is relevant to many respiratory diseases. Future research is warranted to continue to characterization of basic mechanisms underlying dysanapsis, with the eventual goal of translational knowledge of advantageous interventions. Finally, but also perhaps first, the academic community must revisit and expand the definition of dysanapsis. Spirometry, although a useful clinical surrogate, is not sufficient to describe the complexities of airway-parenchymal interactions and interdependence that are altered by differential structural growth. Standing alone, the current spirometric definition of dysanapsis may be too rigid to define the biologic concept of lung growth with development that reflects the dynamic relationship of airways and distal parenchyma on lung function.

Original languageEnglish (US)
Pages (from-to)956-963
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume208
Issue number9
DOIs
StatePublished - Nov 1 2023

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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