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Biomedical research has led to improvements in the diagnosis and treatment of chronic lung diseases, but the burden of these diseases to the U.S. population remains high. Advances in understanding the mechanisms of lung disease have led to the development of clinical management strategies and therapies to control symptoms and reduce progression of disease. However, there has been less emphasis on advancing our understanding of the mechanisms that underlie protective responses to injury or the aberrant host responses that precede disease. Improving our understanding of the preclinical state could lead to identification of modifiable targets for the primary prevention of incident disease.
It is not always clear where basic science fits when describing an agenda for primary prevention research. Important concepts for the primary prevention of chronic lung disease include understanding what exposures and host responses contribute to disease pathogenesis, and why many individuals with the same exposures are resilient and never develop disease; for example, are there protective host factors that explain why only about 20% of life-long smokers develop clinically recognizable symptoms of chronic obstructive lung disease? Disease susceptibility and/or initiation likely begin before clinically apparent symptoms and signs....